Division of Neurotology
Vanderbilt University Medical Center
POLICY AND PROCEDURE MANUAL
TABLE OF CONTENTS
Division of Neurotology
Vanderbilt University Medical Center
POLICY AND PROCEDURE MANUAL
I.
THE OTOLOGY GROUP MISSION STATEMENT/GOALS AND OBJECTIVES
II.
EDUCATIONAL AND TECHNICAL GOALS AND OBJECTIVES
III.
SUPERVISORY LINES OF RESPONSIBILITY
IV.
EVALUATIONS
V.
RESIDENT DUTY HOURS GUIDELINES, ON-CALL ACTIVITIES, MOONLIGHTING
VI.
NEUROTOLOGY CONFERENCE SCHEDULE
VII.
HOUSESTAFF LEAVE POLICY/VACATION
VIII.
HOUSESTAFF COMPLAINT/GRIEVANCE PROCEDURE/DISCIPLINARY ACTION
IX.
BENEFITS/HOUSESTAFF STIPENDS
X.
ACGME PROGRAM REQUIREMENTS FOR GRADUATE MEDICAL EDUCATION IN
NEUROTOLOGY
XI.
DEFINITIONS OF THE 3 LEVELS OF RESIDENT INVOLVEMENT IN SURGICAL PROCEDURES
XII.
CASE ENTRY FOR OTOLARYNGOLOGY AND ALL SUBSPECIALTIES
XIII.
AVAILABLE CPT CODES BY AREA AND TYPE
THE OTOLOGY GROUP
MISSION STATEMENT/
GOALS AND OBJECTIVES
The Otology Group of Vanderbilt
Mission Statement
The mission of The Otology Group of Vanderbilt is to provide patients with the highest
quality of care in a compassionate environment, to improve upon current clinical treatments
through the conduction of ethical and relevant clinical and basic science research, and to train
motivated individuals to disseminate these goals and become future leaders in the field of
Otology/Neurotology.
Goals and Objectives
The neurotology fellowship program and its faculty are charged with excellence in
patient care as well as the responsibility of producing capable neurotologists. The neurotology
fellow is able to refine his or her diagnostic experience through a supervised and graduated
experience. This approach allows the fellow to develop expertise in treatment strategies to
skillfully manage the gamut of neurotologic diseases. The fellowship curriculum is based on
the core they have received in residency. All fellows must have completed an ACGMEaccredited otolaryngology–head and neck surgery residency. The candidates are selected
based on their demonstration of excellence in patient care and commitment to research.
We emphasize an interdisciplinary approach to the clinical diagnosis and surgical
management of neurotology problems. This approach incorporates a core curriculum in
neurotology with supplementation from the many different specialties that play a role in the
care of the neurotology patient. The specialty of neurotology is quite diverse and draws on
the expertise of other fields including, neurosurgery, neurology, audiology, physiology,
rehabilitation medicine, physical therapy, head and neck surgery, reconstructive surgery,
neuroradiology, interventional radiology, and neuropathology. A comprehensive training
program for neurotology fellowship must incorporate teaching from all of these specialties.
The curriculum for this program addresses this need by providing didactic and hands-on
experience in all of these specialties. This program has a unique strength in that all institutions
at which the fellows train have particular areas of expertise and they will be utilized to the
fullest to provide a rich and diverse educational experience. The fellowship rotations are
designed to provide fundamental educational building blocks on which subsequent rotations
can build.
The two years of the program are divided into three-month rotations. The fellows will
have rotations at Baptist Hospital, Vanderbilt University Hospital and St. Thomas Hospital in
each of the two years. Each three-month block will capitalize on the experiences gained in the
previous three months. The goals and objectives of each block are designed to provide
fundamental teachings that will be used throughout the fellowship. The fellow spends
extensive time in the temporal bone lab under the direction of faculty throughout their time
with us. They will incorporate skills they have developed in the temporal bone lab into the
operating room. The concept of graduated responsibility is introduced. As the fellows
demonstrate mastery of a certain skill, they will then move on to more advanced techniques.
This strategy is employed in surgery for chronic ear disease, otosclerosis, Ménière’s disease,
acoustic neuroma surgery and skull base surgery. They will also be expected to develop a
more comprehensive physical exam and mature medical decision-making as they mature in the
program.
The core competencies are incorporated into the curriculum design. We will use
several evaluation tools to ensure that they are covered completely. Each fellow will have a
portfolio where evaluations will be kept, along with documentation of research projects in
which they are involved. The portfolio will include examples from patient charts that
demonstrate clinical judgment and reasoning, including history and physical exam and
operative reports. HIPAA regulation compliance will be assured at all times. Surgical skills
and clinical skills will be assessed regularly throughout the fellowship using various tools.
Medical knowledge will be assessed by analysis of the history and physical taken by the fellow,
end-of-day conferences, mock oral exams and discussions of neurotology literature.
Professionalism is stressed throughout the fellowship and will be assessed using a 360-degree
evaluation tool. Personal interactions between the fellow and faculty will also weigh heavily in
the assessment of professionalism. The 360-degree tool will also help assess the fellows’
interpersonal and communication skills. Fellows are expected to contribute to the neurotology
literature, which will require an understanding of data collection and analysis, data gathering
using computer databases and Medline searches. The process of writing research papers is
taught to the fellows and involves self-critique and acceptance of criticism to facilitate
improvement in writing skills. Fellows are intimately involved in all aspects of patient care,
from returning telephone calls to writing medical necessity letters. They will be educated in
cost-effective medicine practices and will work closely with nurses, physical therapists, social
workers and consulting physicians to provide optimal patient care. All of these measures will
produce a well-rounded clinician who is well equipped to handle all aspects of neurotologic
medicine.
The curriculum is divided into cognitive and technical goals for the fellows to achieve. The
cognitive goals represent the educational aspects that teach the core medical knowledge
necessary for the practicing neurotologist. The technical goals are designed to teach the
surgical skills used in neurotology. The means for achieving each goal presented here is
represented by the objectives that follow each goal. Each goal is achieved by utilizing
objectives that are distributed throughout the block rotations of the fellowship. In achieving
each cognitive and technical goal, the core competencies are addressed.
EDUCATIONAL AND TECHNICAL
GOALS AND OBJECTIVES
Goals and Objectives: Neurotology Fellowship
Neurotology: Block 1, Year 1
During the first three months of Neurotology training, the fellow spends three months on the
neurotology service. This rotation is directed toward developing clinical skills, taking a history and
performing a physical examination of the head and neck and neurologic examination, as well as
determining the diagnosis and treatment of common pathologic conditions encountered in the field
of Neurotology. Special attention is focused on becoming an effective member of the neurotologic
team that integrates with clinic staff, OR staff, neurosurgery, audiology and multiple other ancillary
services. All of the fellows participate in the outpatient clinical activities and gain significant
experience in examination techniques, developing diagnostic abilities, and formulating treatment
plans in otology and neurotology on pediatric, adult, and geriatric populations.
This first rotation is also designed to provide exposure to audiologic and vestibular diagnostic testing
that are used throughout the fellowship to establish and refine a neurotologic differential diagnosis.
The first rotation is also designed to provide a broad overview of neurotology and related services
and the diagnosis of pathologic conditions and recognition of complications in a timely fashion.
Exposure and experience with the following surgical procedures are required from the Neurotology
fellows: middle ear surgery, tympanoplasty, tympanomastoidectomy, stapedectomy, endolymphatic
sac surgery, craniotomy for suboccipital vestibular nerve section,
labyrinthectomy,
translabyrinthine, middle fossa, and suboccipital craniotomy for CPA tumors, microsurgical
techniques for lateral skull base surgery, secondary dura repair for CSF leak, anterior, middle or
posterior cranial fossa surgery of the skull base and cochlear/brainstem implants in a step-wise,
graduated fashion.
Attendance at clinical conferences held at Vanderbilt is required of all fellows regardless of the
rotation to which they are assigned. The fellow is required to present at the neurotology
conferences, otolaryngology resident conferences, the neurotology case conferences, the
neurosurgical case conferences, and lead discussion at the neurotology journal club conference.
Patient Care
GOALS
1. To gain expertise in the head and neck/neurotologic exam, and evaluation of outpatients with
diseases of the ear, hearing and balance
2. To gain proficiency in the postoperative management of neurotologic patients
3. Gain understanding of Neurosurgery techniques and approaches
4. Gain expertise in endolymphatic sac surgery
5. To gain expertise in suboccipital vestibular nerve section
6. Gain expertise in labyrinthectomy
7. Gain experience in gentamicin perfusion of the middle ear
8. Gain experience in steroid perfusion of the middle ear
9. Gain understanding of superior semicircular dehiscence repair
10. Gain understanding of cerebellopontine angle tumors
11. Gain expertise in lateral skull base tumors
12. Gain expertise in cochlear implants and brainstem implantation
13. To gain proficiency in the evaluation of inpatients with diseases of the ear, hearing and balance.
14. To gain expertise in evaluation of hearing loss and vestibular disorders
15. Gain expertise in basic neurology
OBJECTIVES
1. Learn the general and focused adult and pediatric neurotologic history and physical and present
findings in a concise and focused manner.
2. Be able to write daily patient care notes, and write daily orders in the postoperative patient.
3. Improve diagnostic skills via use of the office microscope
4. Gain proficiency in recognition, and management of neurosurgical complications
5. Gain proficiency in incision planning and simple mastoidectomy for endolymphatic sac surgery
6. Gain proficiency in incision planning and flap elevation in suboccipital vestibular nerve section
7. Gain proficiency in incision planning and simple mastoidectomy in labyrinthectomy
8. Gain proficiency in expectations, dosing and scheduling in gentamicin perfusion of the middle
ear
9. Gain proficiency in expectations, dosing and scheduling in steroid perfusion of the middle ear
10. Gain proficiency in understanding pathophysiology, radiology and exam finding in superior
semicircular dehiscence
11. Gain proficiency in incision planning, simple mastoidectomy (translabyrinthine),
incision/craniotomy planning (middle fossa) and incision planning/flap elevation (suboccipital)
for CPA tumors
12. Perform incision planning, flap design, CSF management, carotid artery management and simple
mastoidectomy in lateral skull base surgery.
13. Gain understanding of anatomy for cochlear /brainstem implantation, safely perform
mastoidectomy.
14. Be able to present a differential diagnosis of pathologic conditions of the vestibular system and
their clinical presentation and disease processes such as Ménière’s disease, benign positional
vertigo, superior semicircular canal dehiscence, labyrinthine dysfunction, stroke, multiple
sclerosis and prebycusis.
15. Improve diagnostic skills in patients with complaint of hearing loss and imbalance.
16. Improve diagnostic and differential diagnosis in patients with neurologic disorders including
stroke, migraine, central vertigo, and multiple sclerosis
Medical Knowledge
GOALS
1. To understand ear anatomy and perform the fundamentals of otologic surgery, sterile technique
and microsurgical technique.
2. Understand anatomy and physiology of the vestibular system and apply that to treatment of
outpatients with hearing and balance disorders.
3. Understand central vestibular pathways, their anatomy and physiology in the brainstem,
cerebellum cerebral cortex and spinal tracts
4. Understand function of the utricle, saccule and semi-circular canals
5. Understand the physiologic basis for posture control, visual tracking and the vestibular ocular
reflex
6. To gain proficiency in basic auditory anatomy and physiology.
OBJECTIVES
1. Be able to present a differential diagnosis for the patient with hearing loss, tinnitus, and balance
dysfunction.
2. Gain competency in the components and relevance of electronystagmogram
(videonystagmogram), caloric testing, testing of the vestibular ocular reflex, positional testing,
rotational chair, and vestibular evoked myogenic potentials (VEMP)
3. Gain proficiency in rehabilitation of both sensorineural and conductive hearing loss.
4. Understand external ear, tympanic membrane, middle ear, ossicular chain, cochlea and brainstem
anatomy/physiology.
Professionalism and Interpersonal Communication Skills
GOALS
1. Become a collaborative member of the neurotologic healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare plans
to the families in terms they understand.
3. Effectively utilize the medical record for neurotologic patients, and document medical records
both in the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated adult and pediatric neurotology healthcare team.
2. Become a collaborative member of an integrated adult and pediatric cochlear implant healthcare
team.
3. Understand the complexities of an integrated neurotologic/neurosurgical healthcare team.
OBJECTIVES
1. Work effectively in the hospital, and use resources in a cost-effective manner.
2. Work as a collaborative member of the healthcare team to minimize the length of stay for
inpatients.
3. Move seamlessly between the clinic sites and hospital operating room sites in an efficient
manner.
4. Understand the audiologist’s perspective in their role as part of the neurotology team from
rehabilitation via hearing aids, implantable devices, bone-anchored hearing aids and cochlear
implants.
5. Understand the business model and economic issues of rehabilitation
6. Work as a collaborative member of the neurosurgical team to effect positive communication and
improve patient outcomes
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity).
2. Fellows should demonstrate knowledge of basic principles of research design, clinical
epidemiology and biostatistics. This should include the design, implementation, analysis and
presentation of a research project plan.
3. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
4. Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Block 2, Year 1
This rotation is directed toward developing advanced clinical skills, taking a history and performing a
physical examination of the head and neck and neurologic examination, as well as determining the
diagnosis and treatment of common pathologic conditions encountered in the field of neurotology.
Developing a proper differential diagnosis is emphasized. Exposure and experience with the
following surgical procedures is required from the neurotology fellows: middle ear surgery,
tympanoplasty, tympanomastoidectomy, stapedectomy, endolymphatic sac surgery, craniotomy for
suboccipital vestibular nerve section, labyrinthectomy, translabyrinthine, middle fossa, and
suboccipital craniotomy for CPA tumors, microsurgical techniques for lateral skull base surgery,
secondary dura repair for CSF leak, anterior, middle or posterior cranial fossa surgery of the skull
base cochlear/brainstem implants in a step-wise, graduated fashion.
Proficiency in interpretation and diagnosis of neurotologic and otologic disease, pathologic temporal
bone anatomy and radiologic landmarks via CT, MRI, MRA and CTA as well as other radiologic
tests is emphasized as well as developing superior skills in chronic ear disease management.
Attendance at clinical conferences held at Vanderbilt is required of all fellows regardless of the
rotation to which they are assigned. The fellow is required to present at the neurotology
conferences, otolaryngology resident conferences, the neurotology case conferences, the
neurosurgical case conferences, and lead discussion at the neurotology journal club conference.
Patient Care
GOALS
1. To gain proficiency in the evaluation of outpatients with chronic infections of the ear.
2. To gain proficiency in the evaluation of conductive hearing loss
3. To gain expertise in complex infections of the ear and temporal bone and skill in the
identification and management of complications of these infections.
4. Gain proficiency in evaluation of patients with chronic ear disease, middle ear disease and
external ear disease.
5. Gain expertise in endolymphatic sac surgery
6. To gain expertise in suboccipital vestibular nerve section
7. Gain expertise in labyrinthectomy
8. Gain understanding of cerebellopontine angle tumors
9. Gain expertise in lateral skull base tumors
10. Gain expertise in cochlear implants and brainstem implantation
OBJECTIVES
1. Develop a differential diagnosis and diagnostic workup of a patient with hearing loss or vertigo
2. Properly identify pathology on audiologic examinations and understand its diagnostic
significance.
3. To gain proficiency in stapedectomy procedures
4. To gain proficiency in complete mastoidectomy, both intact and canal-wall down procedures.
5. Gain proficiency in interpreting imaging studies
6. Gain proficiency in complete mastoidectomy for endolymphatic sac surgery
7. Gain proficiency in suboccipital craniotomy, nerve identification, dural closure, and CSF
management in suboccipital vestibular nerve section.
8. Gain proficiency in complete mastoidectomy in labyrinthectomy
9. Gain proficiency in mastoidectomy (translabyrinthine), complete craniotomy(middle fossa)
craniotomy/nerve identification (suboccipital) for CPA tumors
10. Perform complete mastoidectomy in lateral skull base surgery.
11. Safely perform complete mastoidectomy in cochlear/brainstem implants
Medical Knowledge
GOALS
1. To understand the pathophysiology of chronic infections and the effect on hearing.
2. To understand temporal bone anatomy and gain expertise in tympanoplasty,
tympanomastoidectomy and microsurgical techniques of the middle ear.
3. To gain expertise in the management of complications of chronic ear disease.
4. Understand and gain proficiency in evaluating and treating conductive hearing loss.
5. To gain experience in pediatric and adult pediatric cochlear implant surgery, candidacy and
rehabilitation
6. Understand utility of vestibular rehabilitative techniques
7. Understand concepts of neuroradiology
OBJECTIVES
1. Be able to describe surgical options, provide informed consent for tympanic membrane
perforation without cholesteatoma
2. Describe a proper informed consent informing the risks, benefits and alternatives of various
surgical techniques based on direct observation, didactic training and review of the literature
3. Be able to describe surgical options for cholesteatoma
4. Understand indications for ossicular chain reconstruction, tympanoplasty, mastoidectomy
5. Have a clear understanding of single stage vs. staged cholesteatoma surgery
6. Understand and be able to discuss rates of recurrence, graft failure, prosthesis extrusion and
complications
7. Understand the natural history of untreated cholesteatoma and of untreated chronic suppurative
otitis media
8. Become familiar with the knowledge of current literature of cholesteatoma and chronic
suppurative otitis media
9. Be able to describe indications and contraindications for stapes surgery
10. Be able to provide informed consent for stapes surgery and the descriptions of risks, benefits
and alternatives of the procedure
11. Understand complication rates and expected surgical results
12.
13.
14.
15.
16.
17.
18.
Understand the basic function of the ossicular prosthesis
Become proficient in the basic function of different surgical techniques including use of the
laser, use of otologic drills, use of stapedectomy vs. stapedotomy
Understand alternatives to surgery including further observation and hearing aids
Properly identify patients who may benefit from advanced hearing technology
Understand the function of platform posturography
Understand the utility and basic concepts of vestibular exercises
Proficiency in interpretation and diagnosis of neurotologic and otologic disease, pathologic
temporal bone anatomy and radiologic landmarks via CT, MRI, MRA and CTA as well as other
radiologic tests.
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the neurotology healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
3. Effectively utilize the electronic medical record for neurotology patients, and document medical
records both in the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated neurotologic healthcare team
2. Understand the dynamics and interaction of the cochlear implant team.
OBJECTIVES
1. Work effectively in the Vanderbilt Hospital, and use resources in a cost-effective manner.
2. Work as a collaborative member with the clinic and operating room healthcare team to improve
efficiency and elevate patient care for Vanderbilt patients.
3. Work effectively with implant team members in audiology, speech therapists, surgeons,
educators, industry representatives, social workers.
4. Overall understanding of the vestibular rehabilitation specialists and how they function as part
of the neurotology team
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
2. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
3. Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Block 3, Year 1
This rotation is directed toward developing skills in the interpretation of advanced diagnostic
vestibular testing, complex issues of adult and pediatric rehab issues pertaining to conductive and
sensorineural hearing losses, and to present a differential diagnosis of pathologic conditions of the
vestibular system and their clinical presentation and disease processes such as Ménière’s disease,
benign positional vertigo, superior semicircular canal dehiscence, labyrinthine dysfunction, stroke,
multiple sclerosis and presbycusis.
All of the blocks emphasize surgical technique and further exposure and experience with the
following surgical procedures are required from the Neurotology fellows as the fellowship
progresses:
middle ear surgery, tympanoplasty, tympanomastoidectomy, stapedectomy,
endolymphatic sac surgery, craniotomy for suboccipital vestibular nerve section, labyrinthectomy,
translabyrinthine, middle fossa, and suboccipital craniotomy for CPA tumors, microsurgical
techniques for lateral skull base surgery, secondary dura repair for CSF leak, anterior, middle or
posterior cranial fossa surgery of the skull base cochlear/brainstem implants in a step-wise,
graduated fashion.
The responsibilities of the fellows during this rotation include seeing all outpatient and inpatient
consultations primarily and reviewing these with attending physicians responsible for consultations
that day. This may include consultations from the emergency room. The fellow will continue to gain
experience and comfort in the management of neurotology patients. Increasing responsibilities are
reflected by the fellow’s teaching of otolaryngology residents, medical students and residents of
other programs in the Vanderbilt system.
Patient Care
GOALS
1. To gain expertise in the advanced history of the patient with vertigo
2. To understand surgical and nonsurgical options in patients with vertigo of inner ear origin
3. To gain expertise in Ménière’s disease and other disorders of the inner ear.
4. To gain experience in auditory rehabilitation
5. Gain expertise in endolymphatic sac surgery
6. To gain expertise in suboccipital vestibular nerve section
7. Gain expertise in labyrinthectomy
8. Gain understanding of cerebellopontine angle tumors
9. Gain expertise in lateral skull base tumors
10. Gain expertise in cochlear implants and brainstem implantation
11. Gain an understanding of stereotactic radiosurgery as it pertains to neurotology
OBJECTIVES
1. Learn the general and focused pediatric and adult neurotologic history & physical, and present
the findings in a concise and focused manner.
2. Become proficient in vestibular diagnostic bedside testing
3. Become proficient in the interpretation of advanced diagnostic vestibular testing.
4.
5.
6.
7.
8.
9.
10.
11.
Understand the complex issues of adult and pediatric rehab issues pertaining to conductive and
sensorineural hearing losses
Gain proficiency in facial nerve identification and sac identification for endolymphatic sac
surgery
Gain proficiency in complete craniotomy in suboccipital vestibular nerve section
Gain proficiency in facial nerve identification in labyrinthectomy
Gain proficiency in facial nerve identification (translabyrinthine), dural elevation (middle fossa)
complete craniotomy (suboccipital) for CPA tumors
Perform facial nerve identification, facial recess, and extended facial recess in lateral skull base
surgery.
Safely perform facial nerve identification /facial recess in cochlear/brainstem implants
Be able to describe indications and contraindications for skull base tumors including glomus
tumors, meningiomas, temporal bone malignancies and other temporal bone, posterior fossa,
sphenoid wing and lateral skull base tumors
Medical Knowledge
GOALS
1. Learn the pathophysiology, signs and symptoms, differential diagnosis and treatment of
Ménière’s disease
2. Gain proficiency in the general medical and surgical management of inner ear disease.
3. Understand the complexities of the surgical management of Ménière’s disease.
4. Gain proficiency in diagnosis and rehabilitation of adult and pediatric conductive and
sensorineural hearing loss
5. Understand the basic concepts of radiation oncology and application of the radiation system
6. Understand the basics of neuropathology
OBJECTIVES
1. Be able to present a differential diagnosis of pathologic conditions of the vestibular system and
their clinical presentation and disease processes such as Ménière’s disease, benign positional
vertigo, superior semicircular canal dehiscence, labyrinthine dysfunction, stroke, multiple
sclerosis and prebycusis.
2. Be able to describe surgical management of Ménière’s disease
3. Be able to provide informed consent, risks, benefits and alternatives of the various surgical
procedures used to treat Ménière’s disease
4. Understand indications and contraindications of endolymphatic sac decompression, vestibular
nerve section, transtympanic dexamethasone and gentamicin perfusion, labyrinthectomy and the
Meniett™ device
5. Understand risks of vertigo control rates and hearing loss and other complications of each of
these surgical options will be understood, in-depth knowledge of Ménière’s disease literature is
expected
6. Hands-on experience and observation with a basis on electronystagmography (ENG), vestibular
myogenic evoked potential (VEMP), rotational chair testing and posturography Learn how to
interpret ENG, rotational chair, VEMP and posturography
7. Be able to discuss rehabilitation of pediatric hearing loss
8. Gain competency in evaluation, fitting and rehabilitation with both analog and digital hearing
aids
9. Perform candidacy evaluation for and Rehabilitation with bone anchored hearing aids
Understand basic execution of the audiometer
Understand basic observation of audiometric techniques
Understand air and bone audiology, clinical use of masking, acoustic reflex testing and
tympanometry.
13. Understand speech audiometry and special techniques in audiology including Stenger testing and
test for malingering.
14. Become proficient in the overall concepts of stereotactic radiosurgery
15. Become proficient in microscopic appearance and common otologic and neurotologic pathology
and understanding of basic neurotologic pathology is stressed with the ability to recognize
benign and malignant tumors of the ear and temporal bone
10.
11.
12.
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the neurotologic healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
3. Effectively utilize the electronic medical record for neurotology patients, and document medical
records both in the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated neurotologic healthcare team.
OBJECTIVES
1. Work effectively in the hospital, and use resources in a cost-effective manner.
2. Work as a collaborative member of the neurotology healthcare team to improve patient care and
efficiency.
3. Interact with the vestibular team (audiologists, Au.D., Ph.D.) to affect improved patient care.
4. Knowledge of the radiation oncologist, neurosurgeon and the rest of the stereotactic radiation
team as part of the neurotologic multi-disciplinary team
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
3. Fellows should understand the basic aspects of quality of care issues and assessment tools.
2.
Neurotology: Block 4, Year 1
This rotation is directed toward issues with practice development, referrals, physician interaction,
committee involvement, interpersonal skills, systems-based practice, marketing and budgeting. All of
the rotations involve some time at our private office where these skills may be developed.
Continued experience in a stepwise fashion with the following surgical procedures are required from
the Neurotology fellows: middle ear surgery, tympanoplasty, tympanomastoidectomy, stapedectomy,
endolymphatic sac surgery, craniotomy for suboccipital vestibular nerve section, labyrinthectomy,
translabyrinthine, middle fossa, and suboccipital craniotomy for CPA tumors, microsurgical
techniques for lateral skull base surgery, secondary dura repair for CSF leak, anterior, middle or
posterior cranial fossa surgery of the skull base cochlear/brainstem implants.
Leadership skills continue to be developed.
Specific goals and objectives are as follows:
Patient Care
GOALS
1. Gain expertise in endolymphatic sac surgery
2. Gain expertise in labyrinthectomy
3. Gain understanding of cerebellopontine angle tumors
4. Gain expertise in lateral skull base tumors
5. Gain expertise in management of complications of cranial nerve deficits/ CSF leaks
6. Gain expertise in cochlear implants and brainstem implantation
OBJECTIVES
1. Gain proficiency in complete exposure of the sac and incision of the sac for endolymphatic sac
surgery
2. Gain proficiency in identifying and removal of labyrinth in labyrinthectomy
3. Gain proficiency in skeletonizing and removal of the labyrinth, dural and sigmoid sinus
(translabyrinthine), exposure of the internal auditory canal (suboccipital) for CPA tumors
4. Perform exposure of tympanic and petrosal segments of the carotid artery in lateral skull base
surgery.
5. Gain proficiency in techniques for infratemporal fossa approaches, transpetrosal approaches,
transphenoidal and transmaxillary approaches and other anterolateral and posterior skull base
approaches.
6. Gain proficiency in techniques for cerebrospinal fluid leak with vascularized grafts, speech and
swallowing rehabilitation with vocal cord mobilization techniques velopharyngeal insufficiency
correction
7. Safely perform cochleostomy in cochlear/brainstem implants
Medical Knowledge
GOALS
1. Understand the fundamentals of setting up a community practice including contract negotiation,
space/personnel needs, developing a budget, and marketing issues
OBJECTIVES
1. Discuss the key aspects of a job search at the end of residency
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the St. Thomas healthcare team.
2. Understand physician coding and billing responsibilities, and the documentation necessary to
support these activities
3.
4.
5.
Understand and gain proficiency in medical correspondence with non-otolaryngology colleagues
Become an empathetic and trusted physician.
Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Properly code a complex surgery and appropriately dictate an operative note for this
3. Dictate letters to referring physicians after seeing patients, and dictate letters of referral to
potential consulting physicians
4. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
5. Effectively utilize the medical record for St. Thomas patients, and document medical records
both in the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated St. Thomas healthcare team.
OBJECTIVES
1. Work effectively in the St. Thomas Hospital, and use resources in a cost-effective manner.
2. Work as a collaborative member of the St. Thomas healthcare team to minimize the length of
stay for St. Thomas inpatients.
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
2. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
1.
3.
Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Block 1, Year 2
Special attention is focused on understanding of the treatment options available to patients with
acoustic neuroma tumors and understanding of the pathophysiology of, and indications for,
stereotactic radiosurgery and to gain expertise and understand rehabilitative and reconstructive
approaches.
Exposure and experience with the following surgical procedures are required from the Neurotology
fellows: middle ear surgery, tympanoplasty, tympanomastoidectomy, stapedectomy, endolymphatic
sac surgery, craniotomy for suboccipital vestibular nerve section, labyrinthectomy,
translabyrinthine, middle fossa, and suboccipital craniotomy for CPA tumors, microsurgical
techniques for lateral skull base surgery, secondary dura repair for CSF leak, anterior, middle or
posterior cranial fossa surgery of the skull base cochlear/brainstem implants in a step-wise,
graduated fashion.
Specific goals and objectives are as follows:
Patient Care
GOALS
1. Understand basic positioning and monitoring of neurotologic procedures
2. Gain expertise in approaches for acoustic neuroma
3. Gain expertise in stereotactic radiosurgery
4. Gain understanding of cerebellopontine angle tumors
5. Gain expertise in lateral skull base tumors
6. Gain expertise in brainstem implantation
7. Gain expertise and understand rehabilitative and reconstructive approaches
OBJECTIVES
1. Gain proficiency in positioning, head frame, cranial nerve monitoring.
2. Gain proficiency skeletonizing the internal canal (translabyrinthine), bone dissection (middle
fossa) complete internal canal and facial nerve identification(suboccipital) for CPA tumors
3. Perform facial nerve mobilizing techniques in lateral skull base surgery.
4. Safely perform electrode insertion in cochlear/brainstem implants
5. Perform vascularized pedicle flaps for skull base reconstruction
Medical Knowledge
GOALS
1. Gain an understanding of the pathophysiology of cerebellopontine angle tumors
2. Gain an understanding of the treatment options available to patients with acoustic neuroma
tumors.
3. Gain an understanding of the pathophysiology of and indications for stereotactic radiosurgery.
OBJECTIVES
1. To be able to describe indications and contraindications for acoustic neuroma surgery
2. Be able to provide informed consent, discuss risks, benefits and alternatives of various treatment
mechanisms for acoustic neuroma surgery
3. Understand natural history and growth rates of acoustic neuroma surgery
4. Understand suboccipital, translabyrinthine and middle fossa approaches for acoustic neuroma
Understand risks and benefits of each of these surgical approaches
Understand hearing preservation rates and facial nerve function preservation for each of the
above surgical approaches
7. Understand the indications for each approach based on the clinical condition encountered
8. Understand the basic indications for stereotactic radiation
a. Stereotactic radiation literature will be discussed and reviewed
b. Cranial nerve and hearing outcomes following stereotactic radiation will be understood
9. Tumor control rates as compared to natural history will be reviewed and understood
5.
6.
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the otology healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
3. Effectively utilize the medical record for otology patients, and document medical records both in
the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated otology healthcare team.
OBJECTIVES
1. Work effectively in hospitals, and use resources in a cost-effective manner.
2. Work as a collaborative member of the otology healthcare team to minimize the length of stay
for otology inpatients.
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
2. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
3. Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Block 2, Year 2
This rotation is directed toward developing advanced clinical skills, advanced history and performing
a physical examination of the head and neck and neurologic examination, as well as determining the
diagnosis and treatment of common pathologic conditions encountered in the field of Neurotology.
Advanced disorders are addressed such as bilateral vestibulopathies with associated diagnostic
techniques.
Advanced neurosurgical and neurotologic techniques are further developed.
Specific goals and objectives are as follows:
Patient Care
GOALS
1. Gain expertise of cerebellopontine angle tumors (CPA)
2. Gain expertise in lateral skull base tumors
3. Gain expertise in cochlear implants and brainstem implantation.
4. Gain expertise and understand rehabilitative and reconstructive approaches.
5. Improve pediatric history and physical and presentation skills.
OBJECTIVES
1. Gain proficiency in facial nerve dissection, tumor dissection (translabyrinthine), facial nerve
dissection, tumor dissection (suboccipital) for CPA tumors
2. Safely perform transcochlear and combined approaches to the CPA
3. Manage intracranial tumor in lateral skull base surgery.
4. Safely perform complete mastoidectomy in congenital malformations and revision surgery in
cochlear/brainstem implants
5. Perform dura repair/Eustachian tube obliteration for CSF leak management
6. Effectively develop a differential diagnosis and treatment plan in a complex pediatric patient,
such as vertigo, Intracranial tumor or congenital malformation
Medical Knowledge
GOALS
1. Further understand advanced neurotologic disorders
2. Understand genetics as it relates to neurotology
3. Gain proficiency in advanced vestibular disorders
OBJECTIVES
1. Generate a differential diagnosis and testing plan on patients with CPA tumors, and skull base
lesions
2. Gain basic knowledge of genetic, genetic counseling, diagnostic genetic testing as related to
neurotology
3. Be able to diagnose and treat bilateral disease, perform falls prevention and improve overall
patient care
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the head and neck surgery healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
3. Effectively utilize the medical record for head and neck surgery patients, and document medical
records both in the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated head and neck surgery healthcare team.
OBJECTIVES
1. Work effectively in the Vanderbilt Hospital, and use resources in a cost-effective manner.
2. Work as a collaborative member of the head and neck surgery healthcare team to minimize the
length of stay for head and neck surgery inpatients.
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
2. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
3. Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Block 3, Year 2
This rotation is directed toward developing proficiency in management of complications of middle
ear surgery, pediatric mastoidectomy, pediatric cochlear implant surgery and brainstem
implantation.
Advanced procedures are further refined including: middle ear surgery, tympanoplasty,
tympanomastoidectomy, stapedectomy, endolymphatic sac surgery, craniotomy for suboccipital
vestibular nerve section, labyrinthectomy, translabyrinthine, middle fossa, and suboccipital
craniotomy for CPA tumors, microsurgical techniques for lateral skull base surgery, secondary dura
repair for CSF leak, anterior, middle or posterior cranial fossa surgery of the skull base
cochlear/brainstem implants in a step-wise, graduated fashion.
Specific goals and objectives are as follows:
Patient Care
GOALS
1. Gain expertise in cerebellopontine angle tumors.
2. Gain expertise in lateral skull base tumors
3. Gain expertise in cochlear implants and brainstem implantation
4. Gain expertise and understand rehabilitative and reconstructive approaches
OBJECTIVES
1. Safely skeletonize the internal canal (middle fossa), for CPA tumors
2. Perform approaches to lower cranial nerves and foramen magnum lateral skull base surgery.
3. Safely perform dissection of fourth ventricle, foramen of Luschka, and cochlear nucleus in
cochlear/brainstem implants
4. Understand concepts of swallowing rehabilitation and vocal cord reanimation
Medical Knowledge
GOALS
1. Expand neuroradiology knowledge.
2. Expand knowledge of chronic ear disease and complications of middle ear surgery.
3. Expand knowledge of pediatric cochlear implantation
4. Understand the concepts of interventional neuroradiology
OBJECTIVES
1. Improve interpretation of neurotologic, neurosurgical, head and neck studies, including MRI,
CT, MRA, CTA.
2. Improve the understanding of the patient evaluation and management skills in a patient with
middle ear disease.
3. Improve understanding of special issues with programming
4. Become proficient in troubleshooting poorly performing patients with device integrity checks,
reprogramming, imaging
5. Basic theories regarding indication for interventional neuroradiology are discussed and
understood. Time during this block will be spent both with interventional neuroradiologists and
interventional neurovascular neurosurgeons to gain appreciation for different concepts and
aspects between these two disciplines.
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the pediatric healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
3. Effectively utilize the electronic medical record for pediatric patients, and document medical
records both in the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated healthcare team.
OBJECTIVES
1. Work effectively in the hospital systems, and use resources in a cost-effective manner.
2. Work as a collaborative member of the pediatric cochlear implant team to minimize the length
of stay for pediatric inpatients.
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
2. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
3. Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Block 4, Year 2
The fellow will continue to gain experience and comfort in the management of otolaryngology
patients. Increasing responsibilities are reflected by the fellow’s teaching of medical students,
otolaryngology residents and residents of other programs in the Vanderbilt system.
Fellows are expected to refine diagnostic and treatment skills in this last month of practice.
Research projects, reports, medical records, case logs and all other administrative issues should be
addressed.
Specific goals and objectives are as follows:
Patient Care
GOALS
1. Gain expertise in approaches for acoustic neuroma
2. Gain expertise in stereotactic radiosurgery
3. Gain expertise in of cerebellopontine angle tumors
4. Gain expertise in lateral skull base tumors
5. Gain expertise and understand rehabilitative and reconstructive approaches
OBJECTIVES
1. Safely perform tumor dissection (Middle fossa) for CPA tumors and extended middle fossa
techniques.
2. Perform transpetrosal craniotomy approaches to the petroclival region and cavernous sinus in
lateral skull base surgery.
3. Perform facial nerve grafting, anastomosis, cable grafts and 7-12 anastomoses.
Medical Knowledge
GOALS
1. Gain an understanding of issues related to acoustic tumor management
OBJECTIVES
1. To be able to describe indications and contraindications for acoustic neuroma surgery.
2. Be able to provide informed consent, discuss risks, benefits and alternatives of various treatment
mechanisms for acoustic neuroma surgery.
3. Understand natural history and growth rates of acoustic neuroma surgery.
4. Understand suboccipital, translabyrinthine and middle fossa approaches for acoustic neuroma.
5. Understand risks and benefits of each of these surgical approaches.
6. Understand hearing preservation rates and facial nerve function preservation for each of the
above surgical approaches.
7. Understand the indications for each approach based on the clinical condition encountered.
8. Understand the basic indications for stereotactic radiation as they relate to tumor control and
hearing preservation.
9. Tumor control rates as compared to natural history will be reviewed and understood.
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the otology healthcare team.
2. Become an empathetic and trusted physician.
3. Maintain a high standard of medical recordkeeping.
OBJECTIVES
1. Field consultations in a collegial manner and communicate effectively with consulting physicians.
2. Work effectively and honestly with patients and their families, and communicate healthcare
plans to the families in terms they understand.
3. Effectively utilize the medical record for otology patients, and document medical records both in
the operating room and the clinic appropriately and in a timely manner.
Systems-Based Practice
GOALS
1. Understand the complexities of an integrated otology healthcare team.
OBJECTIVES
1. Work effectively in the St. Thomas Hospital, and use resources in a cost-effective manner.
2. Work as a collaborative member of the otology healthcare team to minimize the length of stay
for otology inpatients.
3. Work with the department administrator and nursing supervisor to understand basic concepts in
neurotologic administrative issues.
Practice-Based Learning and Improvement
GOALS
1. Fellows should continuously evaluate their treatment practices and assimilate appropriate
scientific evidence to improve their patient care.
OBJECTIVES
1. Fellows should establish and monitor personal programs for improvement in their knowledge
and skills (i.e., practice-based improvement activity). Fellows should demonstrate knowledge of
basic principles of research design, clinical epidemiology and biostatistics. This should include
the design, implementation, analysis and presentation of a research project plan.
2. Fellows should demonstrate the ability to conduct a complete research-appropriate search of
both print and electronic format literature.
3. Fellows should understand the basic aspects of quality of care issues and assessment tools.
Neurotology: Medical Research Skills Block 2, Year 1, Block 3, Year 2, Block 4 Year 2
The neurotology fellow is involved in a comprehensive research training program. Dedicated
research time is allocated in both fellowship years, with an allocation of one day each week during all
blocks. Additional research time is allocated in year 1-block 3, and in year 2-blocks 1, 3, and 4. The
time spent engaged in research is not to exceed a total of six months over the two-year fellowship.
The choice of project(s) and faculty mentor(s) is made by the fellow. Guidance in the selection and
design of research projects is provided by the faculty and/or the research director (Robert F.
Labadie, M.D., Ph.D.), and overseen by the fellowship program director. A meeting with the
research director is held at the beginning of each clinical year to develop project objectives, evaluate
progress and address deficiencies. The fellow is expected to gain experience in literature review,
experiment/research design, experimental techniques and pertinent laboratory skills (when
applicable), statistical and descriptive data analysis, manuscript preparation, manuscript publication,
and formal presentation. Gaining knowledge of the function of the IRB, technology transfer, patents
and other institutional research support services is an expected goal. Experience in grant writing and
in obtaining extramural funding is ideal. The pursuit of extramural funding by the fellow, as either a
principal investigator or an assistant researcher, is highly encouraged. The presentation of scholarly
work at national and/or regional meetings is expected, with each fellow expected to submit at least
one project each year of the program. Travel expenses for the fellow are provided for at least one
presentation each year. Academic publication is also expected, with each fellow expected to submit
at least two works for publication in each year of the program. Included in these publications are
textbook chapters, case reports, clinical series, review chapters/publications, editorials, original
bench or clinical research, and other scholarly activity that will contribute to the literature.
Presentation of research updates are factored into the Neurotology lecture schedule as well as the
monthly Otology Division meetings.
Practice Based Learning and Improvement
GOALS
1. Gain an understanding of research theory and principles.
2. Gain proficiency in the development of a research proposal, and in the application for funding.
3. Understand the theory of statistics as it applies to research, and to appropriately use statistical
theory in the generation of a research project
4. Gain expertise in basic science/clinical research methods, specific to a project
5. Understand how to organize a research manuscript, and to successfully complete a manuscript
specific to a chosen project
6. Appreciate the need for multi-disciplinary collaboration for the completion of a research
initiative.
OBJECTIVES
1. Outline the basic parts of a research proposal, and explain potential statistical analyses.
2. Develop a research proposal complete with cost analysis, and use this for an application for
external funding.
3. Choose the correct statistical analyses for this research proposal, and explain the theory behind
it.
4. Explain in detail the research methods for the research project initiated during the research
block.
5. Complete a manuscript draft of the project initiated during the research block.
6. Refine the initial manuscript draft with a research mentor and prepare a final draft for
submission for publication.
Temporal Bone Lab, Block 1-Year 1 and Block 4-Year 2.
Formal temporal bone lab dissection is offered at the very beginning of the fellowship (block 1-year
2) and at the end of the fellowship (block 4-year 2) for comprehensive surgical techniques in
otology/neurotology. The fellows will be directly supervised by the faculty. The neurotology fellows
will also supervise dissection by the otolaryngology residents on the service. Teaching by the fellows
of residents, visitors and students is imperative.
The fellows use the temporal bone lab on an ongoing basis in addition to, and congruent with, the
scheduled rotation of lab assignments based on surgical techniques which are given and signed off
on by the faculty.
Medical Knowledge
GOALS
1. Understand the anatomy of the temporal bone and skull base
2. Gain expertise in the use of the operative drill and microscope
3. Gain expertise in approaches to the middle ear, mastoid, lateral skull base and facial nerve
OBJECTIVES
1. Gain proficiency in mastoidectomy canal-wall up and canal-wall down, techniques
2. Gain proficiency in facial recess approach, identification of basic landmarks including sigmoid
sinus, middle fossa dura, jugular bulb, facial nerve dissection and decompression.
3. Gain proficiency in labyrinthectomy.
Gain proficiency in translabyrinthine dissection, exposure and dissection of the internal auditory
canal.
5. Gain proficiency in facial nerve mobilization, transcochlear dissection, carotid artery dissection,
lateral skull base approach.
6. Gain proficiency in transphenoid and transmastoid approaches to the clivus, lateral skull base
approaches to the temporal portion of the carotid artery and cavernous sinus, middle fossa
approaches and advanced posterior fossa approaches.
4.
Professionalism and Interpersonal Skills
GOALS
1. Become a collaborative member of the neurotology healthcare team. in a teaching role
OBJECTIVES
1. Work effectively teaching otolaryngology residents and medical students anatomy in terms they
understand.
SUPERVISORY LINES OF RESPONSIBILITY
SUPERVISORY LINES OF RESPONSIBILITY
All patients are used for teaching. The resident functions under the direct supervision of the
teaching faculty members. This role provides the resident with an opportunity to clinically function
with a graduated progression of autonomy. This postgraduate stature is predicated upon the
exhibition of the capacity for independent activity. The variation in this capacity defines the level of
supervision required and is individualized. The resident is expected to consult the faculty in all
instances of insecurity. All patient interviews are charted. Faculty review these interactions daily.
Independence is bred, nurtured and developed. Consultations on the ward are seen initially by the
resident. A diagnosis must be made and any diagnostics selected. Faculty then see the patient with
the resident, and critique the resident diagnosis and plan. They discuss all aspects of management.
Residents see their own clinic of problems within the faculty practice. Consultation with the faculty
is desirable and mandatory for difficult problems. All clinical activities occur within a single location
so that faculty are physically present at all times. The faculty see all patients after the resident history
and physical is completed, ensuring that all resident activities are monitored and patient care is
ensured. Their level of supervision ensures a uniform management philosophy as well as nurtures
independent thought and problem solution.
Operatively, graduated independence is again the stated educational strategy. Faculty are present in
the operating room, the early supervision being close “over the shoulder.” Once this stage is
complete, the resident functions independently to achieve graduate technical milestones within each
procedure. Supervisory input is proximate at all times.
The needs and well being of the patient serve as the priority of supervision. Supervision is always
present; sometimes overt in new and/or difficult experiences; sometimes covert within the strategy
of progressive, independent development. Should the resident discover a difficult surgical issue,
faculty advice is immediately available. We prefer to help the resident work through the problem
with our help than to “take the case away.” The interaction is bi-directional, facilitating operative
confidence and mitigating the tendency to not ask for help. Program policy and procedure
regarding resident duty hours at all times complies with national guidelines. The program director is
responsible for monitoring duty hours.
Residents evaluate the faculty semi-annually and can comment on the supervisory skills of the
attending physicians. To assure anonymity of the evaluating resident(s), faculty evaluations are
submitted on an anonymous basis to the Residency Coordinator. These are compiled and submitted
to the Program Director.
If acute problems develop, residents are free to contact the Educational Coordinator immediately
with any deficiencies in supervision by the attending physician(s). Residents are encouraged to point
out deficiencies in supervision when they occur. If the Educational Coordinator is unavailable, the
Program Director will respond to any problems.
EVALUATIONS
MECHANISM FOR FORMAL EVALUATION OF
THE PROGRAM’S EFFECTIVENESS
Overview and Tools: The purpose of the evaluation process is to accumulate
relevant assessments from a variety of resources to constitute a summative evaluation of
fellow competency and program effectiveness. The program’s effectiveness is interpreted as
the cumulative success in achieving competent fellow products over time. The ultimate test
of the program’s effectiveness is the performance on the neurotology accreditation exam and
successful achievement of added qualification in neurotology. The program’s application of
accreditation tools for the determination of effective practices measures fellow achievement
in the core competencies as a direct reflection of the program’s effectiveness.
To the end of evaluating program effectiveness beyond formal assessment of fellow
competency, we add:
 Results of neurotology exam and added qualification
 Results of annual oral exam
 Post fellowship career path and contribution to the subspecialty
 Long-term outcomes
 Results of ACGME and GMEC internal reviews
Although this program has a past life of 30 years and a rich history of perpetual
consistency in producing practitioners who are competent, leaders in field and contributors
to the discipline, the new ACGME format at this new institution has no such history and
presents itself as a new program yet to accumulate such data:
Tools:
The 360-Degree Evaluation-Global Rating process utilizes a survey to generate
information about performance competency specifically the core competencies. It is
completed by faculty, peers, professional and paraprofessionals and clerical staff. A rating
scale in each category is employed to rate frequency of the questioned behavior ; between #5
for “always” and #1 for “never.” It is intended that patients and (administrative) staff will
receive a different questionnaire than will professionals in the fellow’s universe. This reflects
the practical challenge in constructing a universally-appropriate survey for use by all. Results
are confidentially reported to the fellow. The tool predominantly is used to measure
interpersonal and communication skills, professional behavior and some aspects of patient
care and system-based practice.
Checklist Evaluation:
Checklists for the elemental aspects of the core competencies document the
adequacy of performance of each specific behavior or action. Other checklists exist for
documenting achievement in the procedural aspects and inventory of the technical
necessities of neurotology both in the temporal bone dissection lab and the operating room.
The content of the checklists is directly related to the goals and objectives of the core
competencies and the curriculum of the program. The faculty are the evaluators.
The Annual Oral Exam:
The Annual Oral Exam (AOE) is a performance assessment tool in which real
patient cases probe the fellow’s ability to manage the case. Cases are selected to highlight
the fellow’s ability to exhibit his medical knowledge and to demonstrate both intuitive and
deductive diagnostic, clinical, surgical and rehabilitation interpretation and application skills.
“Key features” of each case provide focus. Fundamentals of medical knowledge are
evaluated by probative interrogation. The exam is structured to the complexity level the
fellow should be expected to be able to manage successfully given his/her level of training
and experience. The mock oral exam at the conclusion of year 2 is comprehensive and
should evaluate the (core) competency of a board certified neurotologist. It is expected that
this oral board format assesses fellow competency, program effectiveness and provides a
framework for familiarization with oral exams conducted for board certification.
The exam is administered by the Program Director, neurotology certified faculty and
selected members of the faculty representing the other neurosciences. It is expected to be
given in two sessions of two hours each.
Procedures, Operative Case Logs:
Case and procedure logs document the scope of the fellow’s patient care experience
and the capacity of the program to provide necessary breadth. The logs are reviewed semiannually to track experience as well as to direct the fellow to specific deficiencies the remedy
of which is required to meet learning objectives. The case log numbers are not
representative of competency. Quality of performance of the procedures is validated by the
faculty. Patient outcome is validated by regular record reviews at CC.
Evaluation Format:
This program requires its fellows to develop proficiency in the six core
competencies. The following provides the specific knowledge and skill sets within the
curriculum to be demonstrated by the successful fellow and measurement devices for their
evaluation. Fellows are regularly evaluated on achievement of the competencies.
Demonstration of satisfactory performance within the categorical competencies is required
to successfully complete the program.
Patient Care:
Fellows must be able to provide compassionate, effective and global healthcare. The
fellow is expected to:
 Communicate with patients and families effectively and compassionately
 Gather accurate and necessary patient information
 Make diagnostic and treatment decisions based upon patient data and preferences,
timely scientific data and clinical assessment
 Develop and execute treatment plans
 Advise and educate patients and families
 Reinforce care decisions and directions on patient education with information
technology
 Competently perform procedures essential for neurotology
 Provide healthcare services the purpose of which is disease prevention and health
maintenance
 Involve all necessary healthcare professionals to provide patient focused care
Competency in patient care is assessed by direct observation of the fellow’s patient
care in the clinic and operating room. His/her clinical outcomes are monitored along with
the patient/family interactions. The nightly competencies conference (CC) allows the faculty
regular opportunity to assess the fellow’s demonstration of increasing responsibility,
achievement and maturity in patient care. Surgical achievement is directly monitored by
faculty and reported within semi-annual reviews. Individual adjustments to surgical skill are
made real-time.
Formal evaluation of this competency is achieved employing the following tools:
 360-degree global evaluations: faculty, peer, subordinates, patients, families are
surveyed. Performance is rated on a 1-5 scale. Ratings are summarized semiannually.
 Checklists of essential achievements for elements of this competency are kept.
Faculty evaluators keep the checklist.
 Faculty evaluators employ all tools to formulate a global rating for the fellow’s
overall performance. Performance is rated “superior,” “good,” “fair” and
“substandard.”
 This competency is highlighted on the annual oral examination.
 Procedure and case logs are maintained.
Medical Knowledge:
The fellow must demonstrate basic science and clinical knowledge and its application
to patient care practices.
Fellows must:
 Exhibit inquisitive and analytic applications of medical knowledge to clinical
situations
 Know and apply these supportive sciences
Competency in medical knowledge is regularly evaluated in CC and direct faculty
interaction. The annual oral examination employs chart stimulated recall, patient
simulations and models as well as direct interrogation. Monitoring of clinical outcomes and
360-degree global evaluations are employed.
Practice-Based Learning and Improvement:
Fellows are expected to investigate and evaluate patient care practices, evaluate
scientific evidence and improve their care practices.
They must:
 Analyze practice experience and execute improvement actions using a systematic
method
 Identify and assimilate data related to the patient’s health program
 Obtain and use information about their patients and larger populations from
which their patients come
 Apply study design and statistical methodology to appraise clinical studies and
other info and diagnose and treat effectively
 Use information technology to manage information, access on-line medical
information and support their own education.
 Facilitate the learning of students and other healthcare professionals
Competency in practice-based learning and improvement is assessed by direct
observation of the maturity of process by which the fellow executes and designs patient care.
The nightly CC (with M&M conference) represents a regular opportunity to explore
complications, analyze unintended consequences and to derive a plan, based upon achieving
all of the elemental markers of their competency, to define, develop and to initiate best care
practices. The fellow must demonstrate a willingness to learn, a willingness to investigate
and evaluate patient care and an ability to apply these to self-improvement and patient care.
Within our CC and quality assurance (QA) effort, a clinically-based problem is
identified annually. The fellow is assigned this entity to research employing information
technology to amass a knowledge base on the topic. He/she is then required to assimilate
this information base to derive an improvement plan based upon best available evidence and
available evidence to improve quality. We have investigated CSF leak, wound infection, post
surgical hematoma, etc., and have modified clinical behavior based on this outcome analysis.
This project is mandatory.
This competency is evaluated, as well as the 360-degree global evaluation, the
checklist and annual oral examination which include patient/chart simulations.
Interpersonal and Communication Skills:
Fellows must demonstrate interpersonal and communication skills for effective
information exchange and teaming with all members of the patient, family and professional
healthcare team.
The fellow must:
 Establish and maintain therapeutic and ethically-sound relationships with patients
 Use effective listening skills and provide information employing effective
communication tools, both verbal and nonverbal
 Work effectively with others
Competency in interpersonal and communication skills is assessed by direct
observation of his/her communications with faculty, residents, and professionals from other
disciplines with input from audiology, administration and nursing. The close mentoring and
communicative relationship with faculty quickly identify areas of concern. Direct feedback
on areas and improvement strategies are affected. Presentation effectiveness is evaluated in
the fellow’s teaching conference responsibilities.
This competency is formally evaluated by checklist, 360-degree global rating, and the
annual oral examination which includes simulated patient interaction.
Professionalism:
Competency in professionalism must be demonstrated by a commitment to
professional responsibility, adherence to ethical principles and sensitivity to patient diversity.
Fellows must:
 Demonstrate respect, compassion and integrity; responsiveness to the needs of
the patients and society which supersedes self-interest; accountability to patients,
society and the profession; and a commitment to excellence and a perpetual
professional development
 Demonstrate a commitment to ethical principles pertaining to clinical care
confidentiality
 Demonstrate sensitivity and responsiveness to patient age, culture, gender and
disabilities
Competency in professionalism is assessed by direct observation of the fellow’s
responsibility, decorum, respect for others and self-sacrifice in his/her dealing with patients,
their families and their medical community. The fellow’s care of all ethnic groups, ages,
genders and economic strata is scrutinized in all affiliated hospitals, meeting areas and offcampus activities.
This competency is formally evaluated by the 360-degree global rating, the checklist
and the annual oral examination highlighting chart and patient simulation.
System-Based Practice:
Fellows must exhibit an awareness and responsibility to the larger context and
system of healthcare and the ability to utilize system resources to provide optimal care.
Fellows must:
 Understand how their care and other professional practices affect other
healthcare professionals, the organization of healthcare and the larger society and
vice versa.
 Know how types of medical practice and delivery systems differ from one
another including methods to control cost and allocate resources
 Practice cost effective healthcare and resource allocation that does not
compromise quality of care
 Advocate for quality of patient care and assist patients in dealing with system
complexities
 Know how to partner with healthcare managers and providers to assess,
coordinate and improve healthcare and to acknowledge how these activities can
affect system performance
Competency in system-based practice is assessed by direct observation of the
fellow’s interaction with the multiple disciplines related to neurotology, as well as the entire
healthcare system within the teamwork required for effective neurotologic patient care. The
synergy of all programs for high quality, cost effective care within the program provide a
structured strategy easily observable.
System-based practice is formally evaluated by the 360-degree global rating, the
checklist and annual oral examination which includes chart and patient simulations.
RESIDENT DUTY HOUR GUIDELINES
ON-CALL ACTIVITIES
MOONLIGHTING
RESIDENT DUTY HOURS
The Vanderbilt GMEC is committed to compliance with the ACGME duty hour guidelines. Duty
hours are defined as all clinical and academic activities related to the program; i.e., patient care (both
inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of
patient care, time spent in-house during call activities, and scheduled activities, such as conferences.
Duty hours do not include reading and preparation time spent away from the duty site. Effective July
1, 2011, the following requirements apply to all residency training programs at Vanderbilt:
General Guidelines
1. House Staff are responsible for accurately reporting their duty hours, including all time spent
in Internal and External Moonlighting, per program requirements.
2. Program Directors are responsible for monitoring and enforcing compliance with duty hour
guidelines.
3. If specialty/subspecialty-specific program duty hour requirements as defined by an individual
RRC for that specialty/subspecialty are more restrictive than the above requirements, then the
duty hour requirements of that RRC will be included in the policy of that specialty/subspecialty
program and will supersede the institutional requirements.
4. Concerns regarding duty hours may be reported to the Associate Dean for GME or through the
Confidential Helpline, 615-343-0135. Concerns may be reported anonymously.
Maximum Hours of Work per Week
5. Duty hours must be limited to eighty hours, averaged over a four-week period per rotation or a
four-week period within a rotation excluding vacation or approved leave. Any requests for
exceptions to the maximum weekly limit on duty hours must be presented by the Program
Director to the GMEC for review and approval. Any exceptions must conform to the Policy and
Procedures for Resident Weekly Duty Hour Limit Exceptions.
6. Time spent in Internal and External Moonlighting (as defined in the ACGME Glossary of
Terms and in the Vanderbilt University House Staff Manual) will be counted toward the eightyhour maximum weekly hour limit on duty hours as outlined in #5 above.
Mandatory Time Free of Duty
7. House officers must be scheduled for a minimum of one day free of duty every week (when
averaged over four weeks). “Duty” includes all clinical and academic activities related to the
program as described above. At-home call cannot be assigned on these free days.
Maximum Duty Period Length
8. Duty hour periods of PGY-1 house officers must not exceed 16 hours in duration
9. PGY-2 house officers and above may be scheduled to a maximum of 24 hours of continuous
duty in the hospital. House officers may be allowed to remain on site for an additional four
hours to ensure effective transitions in care; however, they may not be assigned additional
clinical responsibilities after 24 hours of continuous in-house duty.
10. VUMC encourages house officers to use alertness management strategies, including strategic
napping, in the context of patient care responsibilities, especially after 16 hours of continuous
duty and between the hours of 10pm and 8am.
11. In unusual circumstances and on their own initiative, PGY-2 house officers and above may
remain beyond their scheduled period of duty to continue to provide care to a single patient.
Under such circumstances - which only include continuity of care for a severely ill or unstable
patient, a transpiring event of unusual academic importance, or humanistic attention to the
needs of a patient or family – the resident must appropriately hand over the care of all other
patients responsible for their continuing care and document the reasons for remaining to care
for the patient in question. Such documentation must be submitted to the Program Director in
every circumstance. The Program Director is responsible for tracking both individual resident
and program-wide episodes of additional duty.
Minimum Time Off Between Scheduled Duty Periods
12. PGY-1 house officers should have 10 hours and must have 8 hours free of duty between
scheduled duty periods.
13. Intermediate level house officers as defined by the respective Residency Review Committees
should have 10 hours free of duty, must have 8 hours between scheduled duty periods, and must
have at least 14 hours free of duty after 24 hours of in-house duty. Individual residency
programs must construct their own duty hour policies in compliance with their individual
program’s requirements.
14. House officers in the final years of education must be prepared to enter the unsupervised
practice of medicine and care for patients over irregular or extended periods. While it is desirable
that house officers in their final years of education have eight hours free of duty between
scheduled duty periods, there may be circumstances when these house officers must stay on duty
to care for their patients or return to the hospital with fewer than eight hours free of duty.
Individual programs must construct their own duty hour policies in compliance with their
individual program’s requirements as to the definition of “final years of education” and the
circumstances where house officers may have less than 8 hours free between duty periods. In all
instances, such circumstances must be monitored by the Program Director.
Maximum Frequency of In-House Night Float
15. House officers must not be scheduled for more than six consecutive nights of night float.
Individual residency programs must construct their own duty hour policies in compliance with
their individual program’s requirements defining maximum consecutive weeks of night float and
maximum number of months of night float per year.
Maximum In-House On-Call Frequency
16. In-house call will occur no more frequently than every third night, averaged over a four-week
period.
At-Home Call
17. At-home call, or “pager call,” is defined as call taken from outside the assigned site.
18. When house officers are called into the hospital from home, they may care for new or
established patients and the hours spent in-house, exclusive of travel time, are counted toward
the eighty-hour limit. Such episodes will not initiate a new “off-duty period.”
19. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time
for each resident.
20. At-home call may not be scheduled on the resident’s one free day per week (averaged over four
weeks).
Any concerns or questions concerning the hour guidelines must be directed to the Associate Dean
or Administrative Director for GME.
Approved by GMEC: 9/04/03
Revisions Approved by GMEC: 03/14/08
Revisions Approved by Medical Center Medical Board: 04/17/08
Revisions Approved by GMEC: 3/11/11
MOONLIGHTING
The Program Director endeavors to see that moonlighting does not interfere with the ability of the
fellow to achieve the goals and objectives of the educational programs.
The Program Director complies with the written policies and procedures of the affiliate institution
regarding moonlighting. These policies and procedures are in compliance with Vanderbilt
requirements. Should a conflict occur between the policies and procedures for moonlighting of the
affiliate institution and those of Vanderbilt, the Vanderbilt policies and procedures shall prevail.
Moonlighting that occurs within the fellowship program and/or the sponsoring institution will be
counted toward the 80-hour limit on duty hours.
The primary responsibility of fellows is to their postgraduate medical education and to the patients
charged to their care. Inasmuch as extramural professional activities, or “moonlighting,” may
conflict with these responsibilities, such activities will be discouraged.
Moonlighting is prohibited during regular duty hours, as defined by the Program Director.
Moonlighting during periods of authorized absence can occur provided that it does not interfere
with the individual’s primary responsibilities and is properly approved and recorded.
The Program Director reserves the right to deny any specific moonlighting activity that is deemed
inconsistent with policy regarding conflict of interest or other relevant policies.
Violation of these rules constitutes a breach of the House Staff Agreement between Vanderbilt
University and the individual.
For specific moonlighting policies and requirements, please refer to the House Staff Manual, pages
15-17, section I.D.
ON-CALL ACTIVITIES
On-call activities provide residents with continuity of patient care experiences throughout a 24-hour
period. In-house call is defined as those duty hours beyond the normal workday when residents are
required to be immediately available at the affiliate institution and/or Vanderbilt.
In-house call must occur no more frequently than every third night, averaged over a 4-week period.
Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents
may remain on duty for up to 6 additional hours to participate in didactic activities, maintain
continuity of medical and surgical care, transfer care of patients, or conduct outpatient continuity
clinics.
No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity
clinics. A new patient is defined as any patient for whom a resident has not previously provided
care.
At-home call (pager call) is defined as call taken from outside the affiliate institution and/or
Vanderbilt.
The frequency of at-home call is not subject to the every third night limitation. However, at-home
call must not be so frequent as to preclude rest and reasonable personal time for residents.
Residents taking at-home calls must be provided with 1 day in 7 days completely free from all
educational and clinical responsibilities averaged over a 4-week period.
When residents are called to the affiliate institution or Vanderbilt from home, the hours a resident
spends in-house are counted toward the 80-hour limit.
The Program Director will monitor the demands of at-home call and make scheduling adjustments
as necessary to mitigate excessive service demands and/or fatigue.
NEUROTOLOGY
CONFERENCE
SCHEDULE
2011-2012 NEUROTOLOGY RESIDENT LECTURE SERIES
July 2011
6
7:00 AM
No lecture per DSH
13
7:00 AM
Journal Club
20
7:00 AM
27
6:30 AM
27
7:00 AM
Orientation – New Residents and Fellows
Select Articles
Fellows/Attendings
Neurotology Lecture Quality Aspects of Neurotology [Rescheduled]
Marc Bennett
Otology Division Meeting
Neurotology Lecture Image-Guided Surgery
Robert Labadie
Neurotology Lecture Radiosurgery for Acoustic Neuroma
George Wanna
August 2011
3
7:00 AM
10
6:30 AM
10
7:00 AM
17
7:00 AM
Neurotology Lecture Quality Aspects of Otology
Marc Bennett
24
7:00 AM
Neurotology Lecture Neurotology Administrative Issues
Mack Howell
31
7:00 AM
Neurotology Lecture Cochlear Implants: Candidacy Evaluation, Program Activation and Mapping
Rene Gifford
Otology Division Meeting
Journal Club
Select Articles
Fellows/Attendings
September 2011
7
6:30 AM
7
7:00 AM
Otology Division Meeting
Journal Club
Select Articles
Fellows/Attendings
No Conference – Academy Meeting
14
21
7:00 AM
MM&I Conference
VCH-Wadlington
28
7:00 AM
Neurotology Lecture Tumors of the Middle Ear
Betty Tsai
Neuro ICU
October 2011
3
8:00 AM
Brain Tumor Board
5
7:00 AM
Neurotology Lecture
5
6:30 PM
10
8:00 AM
Rank List Meeting [Rank List Due 10/06/2011 before noon] – Las Maracas (Belle Meade)
Brain Tumor Board
12
6:30 AM
12
7:00 AM
Otology Journal Club
17
8:00 AM
Brain Tumor Board
19
7:00 AM
Neurotology Lecture Implantable Neurosurgical Devices
Updated: 02/13/2012
Chronic Ear Presentations
Marc Bennett
Neuro ICU
Otology Division Meeting
Fellows/Attendings
Neuro ICU
Peter Konrad
October 2011 (Continued)
24
8:00 AM
Brain Tumor Board
Neuro ICU
26
7:00 AM
Neurotology Lecture Neurotology Billing & Coding Issues
28
6:45 AM
Neurosurgery Case Conference
31
8:00 AM
Brain Tumor Board
ABarksdale/Lynda
Wright
D-5245 MCN/Blalock
Conf Rm
Neuro ICU
November 2011
2
6:30 AM
Otology Division Meeting
2
7:00 AM
Otology Journal Club
Fellows/Attendings
7
8:00 AM
Brain Tumor Board
9
7:00 AM
Neurotology Lecture Diseases of the External Canal
14
8:00 AM
Brain Tumor Board
Neuro ICU
16
7:00 AM
MM&I Conference
VCH-Wadlington
21
23
25
28
8:00 AM
Brain Tumor Board
Neuro ICU
8:00 AM
Brain Tumor Board
30
7:00 AM
Neurotology Lecture Neurosurgery : The Basics of Shunts and Shunt Surgery
Neuro ICU
Marc Bennett
No Conference – Thanksgiving Holiday
No Neurosurgery Case Conference – Thanksgiving Holiday
December 2011
5
8:00 AM
Neuro ICU
Brain Tumor Board
Neuro ICU
7
7:00 AM
Neurotology Lecture Genetics and Hearing Loss
12
8:00 AM
Brain Tumor Board
14
6:30 AM
14
7:00 AM
Journal Club
19
21
23
26
8:00 AM
Brain Tumor Board
Updated: 02/13/2012
Noel Tulipan
Melinda Cohen
Neuro ICU
Otology Division Meeting
Select Articles
Fellows/Attendings
Neuro ICU
No Conference – Christmas/New Year’s Holidays
No Neurosurgery Case Conference – Christmas/New Year’s Holidays
No Brain Tumor Board – Christmas/New Year’s Holidays
December 2011 (Continued)
28
No Conference – Christmas/New Year’s Holidays
30
No Neurosurgery Case Conference – Christmas/New Year’s Holidays
January 2012
4
7:00 AM Neurotology Lecture Establishing a CI Program
11
6:30 AM
Otology Division Meeting
11
7:00 AM
Annual Retreat to Discuss Fellowship
18
7:00 AM Neurotology Lecture MM&I @ Children’s [Wadlington]
25
7:00 AM
Neurotology Lecture Surgical Guidance Systems: The Inside Story
David Haynes
Stan Pelosi
[Triologic January 26-28, 2012]
Mike Fitzpatrick
February 2012
1
7:00 AM
Neurotology Lecture
Cerebellopontine Angle Neoplasms
8
15
15
7:00 AM
6:30 AM
7:00 AM
Journal Club
Neurotology Lecture
Otology Division Meeting
Skull Base Case Presentations
22
7:00 AM
Neurotology Lecture
Multiple Sclerosis [canceled, need to reschedule, due to site visit]
29
7:00 AM
Neurotology Lecture
Vestibular Case Studies
Select Articles
Ty Abel MD PhD
Fellows/Attendings
Betty Tsai
Harold Moses
Marc Bennett/Devin
McCaslin
March 2012
2
6:30 AM
Combined MMI Conf Langford Auditorium
7
14
14
7:00 AM
6:30 AM
7:00 AM
Neurotology Lecture
21
7:00 AM
Neurotology Lecture
Economic Issues in Clinical Practice [confirmed]
Jerry Crook Jr
28
7:00 AM
Neurotology Lecture
Cochlear Implant Case Studies
Robert Labadie
Journal Club
Fellows/Attendings
Encephalocele/CSF Leak Repair
Otology Division Meeting
Select Articles
David Haynes
Fellows/Attendings
April 2012
4
7:00 AM
11
11
18
6:30 AM
7:00 AM
Updated: 02/13/2012
Neurotology
Lecture
Migraine and Vertigo [emailed 10/22/2011]
Jan Brandes
Otology Division Meeting
Journal Club
Select Articles
Fellows/Attendings
No Conference – COSM [MM&I @ VCH]
2011-2012 Neurotology Resident Lecture Series
Page 3
April 2012 (Continued)
25
7:00 AM
May 2012
2
7:00 AM
9
6:30 AM
9
7:00 AM
Neurotology Lecture
Management of Ménière’s Disease
Neurotology Lecture
Neuroradiology MRI [emailed 10/22/2011]
Otology Division Meeting
Select Articles
Journal Club
George Wanna
Joe Aulino
Fellows/Attendings
16
7:00 AM
Neurotology Lecture
Facial Nerve Neuromas
Alejandro Rivas
23
7:00 AM
Neurotology Lecture
Contemporary Management of Paraganglioma
George Wanna
30
7:00 AM
Neurotology Lecture
The MF Approach
Marc Bennett
June 2012
1
6:30 AM
Combined MMI Conf Langford Auditorium
6
13
13
7:00 AM
6:30 AM
7:00 AM
Neurotology Lecture
20
7:00 AM
27
7:00 AM
Fellows/Attendings
OPEN
Otology Division Meeting
Journal Club
Select Articles
Fellows/Attendings
Neurotology Lecture
MM&I at Children’s [Wadlington]
Fellows/Attendings
Neurotology Lecture
Approaches to Clivus
Stan Pelosi
Conference Locations:
Neurotology Resident Lecture Series: 8349 MCE-ST
Otology Division Meeting: Precedes Journal Club; 8349 MCE-ST
Otology Journal Club: 8349 MCE-ST
Morbidity and Mortality Conference: 8380-B MCE-ST [2nd Friday of each month, 7:00 a.m.]
Quarterly Multidisciplinary Morbidity and Mortality Conference: Langford Auditorium
[Months when quarterly M&M takes place, departmental M&M is canceled and cases for those months presented in subsequent month]
Neurosurgery Combined Case Conference: Blalock Conference Room [D-5245 MCN] – last Friday of each month, 7:45 a.m.
Brain Tumor Board: Neuro ICU, every Monday, 8:00 a.m.
Resident/Fellow Temporal Bone Surgical Dissection Lab: 10th Floor, Temporal Bone Lab. Med Center East South Tower.
CME Credit for Neurotology Resident Lecture Series
Sponsorship Statement: Presented by the Vanderbilt School of Medicine and the Department of Otolaryngology/Division of Neurotology.
Accreditation Statement: Vanderbilt School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education
for physicians.
Designation Statement: Vanderbilt School of Medicine designates this live educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only
claim credit commensurate with the extent of their participation in the activity.
Disclosure Statement: It is the policy of Vanderbilt School of Medicine that participants in CME activities be made aware of any affiliation or financial interest that may affect
the planner’s involvement and speaker’s presentation(s). Each planner and speaker has completed and signed a conflict of interest statement; these relationships will be disclosed
to the audience.
HOUSESTAFF LEAVE POLICY
LEAVE POLICY
Vanderbilt recognizes that a resident may need to be away from work due to medical or
certain family reasons. Leaves of absence are defined as approved time away from residency
duties, other than regularly scheduled days off as reflected in a rotation schedule. All leaves
will be scheduled with prior approval by the Program Director or Chief of Service, with the
exception of emergencies or unexpected illnesses. In unexpected/emergency situations, the
resident should contact the Program Director or Chief of Service at the earliest possible time.
Each residency or fellowship program will provide its house officers with a written policy in
compliance with its Program Requirements concerning the effect of leaves of absence, for any
reason, on satisfying the criteria for completion of that residency or fellowship program. The
amount of time a resident can be away from residency duties and still meet Board
requirements varies among the specialties. It is the resident’s responsibility to be aware of
his/her specialty requirement. Information relating to access to eligibility for certification by
the relevant certifying board is available upon request from the Program Director. If leave
time is taken beyond what is allowable for the specialty board and the resident is required to
extend his/her period of activity in the training program to meet board requirements, the
resident should request permission to extend and should establish a schedule for doing so in
consultation with the Program Director.
Leave time under any of these categories will not be credited as time toward Board eligibility.
When the need/request for leave is foreseeable, the request should be submitted at least thirty
(30) days prior to the leave. When the need for the leave is unforeseeable or the thirty days
notice cannot be given, the request should be submitted as soon as practical.
In order to remain in a paid status, house staff member will utilize sick time first for a leave
related to a medical condition, then vacation time, then will be placed on unpaid leave once all
available paid leave time has been exhausted. House officers MUST obtain a Return to
Work/Physician Release form and return it to Occupational Health who will notify the Program
Director or his/her designee BEFORE the resident may return to work.
1. Family and Medical Leave Act (FMLA) and Tennessee Parental Leave Act (TPLA)
Consistent with the FMLA, eligible house officers are able to take up to 12 weeks of leave
for certain personal medical reasons or for qualifying family reasons. House officers are
eligible if they have worked at least 12 months and have had at least 1250 hours of work.
FMLA leave may be taken to care for a spouse, child or parent with a serious health
condition. If the leave is to care for a newborn, or a recently adopted infant, or infant in
foster care, the TPLA provides an additional 4 weeks (up to 16 weeks) for care and
bonding with the infant. Leave under FMLA or TPLA is either paid or unpaid. Sick and
vacation time must be used before a resident goes into unpaid status; for a medical
condition, the department will use available sick leave first, then vacation time. Health
insurance is maintained throughout the leave period, but if the resident is in unpaid status
she/he must continue to pay her/his share of the cost. A resident who needs medical
leave for a pregnancy related condition, or to recover from childbirth, will use
FMLA/TPLA from the start of the leave. A house officer who is the father of a new born,
newly adopted infant, or one placed in his home for foster care may use FMLA/TPLA for
infant care. In addition, a resident who incurred a serious injury while in active military
duty, or one who has a spouse, child, parent who incurred a serious injury while in active
military duty or one who is the next of kin to an injured service member, may be entitled
to up to 26 weeks of leave, in a 12 month period, for treatment of her/his injury, or care
of the injured service member (Military Caregiver Leave). Also, a resident whose family
member, including next of kin, is called to active duty, or who otherwise incurs a military
related exigency, may be entitled to 12 weeks of FMLA to deal with the problems caused
by the exigency (Qualifying Exigency Leave).
As well as taking FMLA in continuous blocks, for medical conditions, a resident may be
entitled to intermittent leave for treatment appointments, or episodic conditions, for
her/himself or for care of a qualifying family member.
The FMLA process is located here:
http://www.mc.vanderbilt.edu/root/vumc.php?site=gme&doc=33945
Questions regarding FMLA/TPLA leave should be addressed to the Office of Graduate
Medical Education.
2. Parental Leave/Adoption
Parental leave is available to eligible house officers for the birth or adoption of a child
under the FMLA and the Tennessee Parental Leave Act (TPLA). If certain conditions are
met, a resident may be eligible for parental (or other) leave related to adoption, pregnancy,
childbirth, and/or nursing an infant for a period of up to 16 weeks. Time off under the
TPLA and the FMLA runs concurrently. Please see above section on FMLA/TPLA for
more information. If paid sick or vacation time is available, it must be used prior to going
into unpaid status. Contact the Office of GME for more information about qualifying
conditions and the provisions for parental leave under these laws. For care of a newly
adopted child, available vacation and then unpaid leave is used.
3. Medical Leave
Medical leave which is not FMLA eligible is available at the discretion of the Program
Director in 30-day increments up to a maximum of 52 weeks. Medical documentation is
required if the resident is away from work for more than 5 calendar days. House officers
will be required to exhaust other forms of leave for which they may qualify prior to being
eligible for medical leave. If paid sick or vacation time is available, it must be used prior to
going into unpaid status.
4. Education Leave
Education leave may be granted at the discretion of the Program Director.
5. Military Leave/Jury Duty
House officers will be granted military leave or leave for jury duty as required by
applicable law. Please contact the Office of GME for specific questions about such leave.
6. Personal Leave
If a resident does not qualify for FMLA or medical leave, they may be allowed to take
personal leave. Personal leave may be provided at the discretion of the Program Director
in 30-day intervals according to the policies established by the individual residency
Page 50 of 60
programs. House officers will be required to exhaust other forms of leave for which they
may qualify prior to being eligible for personal leave.
7. Bereavement Leave
If there is a death in a house officer’s family, he or she may take up to three working days
off as leave with pay. For this purpose, "family" is defined as spouse, domestic partner,
child, mother, father, mother-in-law, father-in-law, sister, brother, grandparent or
grandchild. Except in very unusual circumstances, bereavement leave must be utilized
within 14 days of the date of death.
Revisions Approved by GMEC: 3/11/2011
Page 51 of 60
VACATION
Residents at Vanderbilt are allowed three weeks (15 working days) of paid vacation and two
days of paid personal leave.
All time off, including holidays, is scheduled at the discretion of the Program Director (leave
request forms available from Program Coordinator). Vanderbilt holidays are not automatically
observed as time off for residents. The schedule changes drastically during the holidays of
Thanksgiving, Christmas and New Year’s and schedule assignments will be made to
accommodate residents spending equal time with their families appropriately.
Vacation time must be used in the appointment year that it is accrued. Any unused time does
not carry over and is not paid out at the appointment year-end.
Page 52 of 60
HOUSESTAFF COMPLAINT/
GRIEVANCE PROCEDURE
HOUSE STAFF COMPLAINT/GRIEVANCE PROCEDURES
Situations may arise in which a resident believes he/she has not received fair treatment by a member
of the faculty or staff of the Medical Center, or a representative of the University; or has a complaint
about the performance, action or inaction of a member of the staff or faculty. Retaliation against a
resident for submitting a dispute through the complaint/grievance procedures will not be tolerated
and will result in appropriate disciplinary actions.
PROCEDURE-HARRASSMENT/DISCRIMINATION/RETALIATION
If the complaint involves allegations of sexual harassment and/or perceived unlawful discrimination
or retaliation, refer to this House Staff Manual, Section I.N.
PROCEDURE–OTHER COMPLAINTS
The House Officer should be directed as soon as possible to the person(s) whose actions or
inactions have given rise to the complaint and not later than ninety (90) days after the event. If the
person(s) involved is not the department chair or Program Director, the resident should consult
with his/her Program Director and/or department chair to seek their assistance in the resolution of
the issue. Every effort should be made to resolve the problem fairly and promptly at this level.
Complaints not resolved at this level within 30 days should be referred to the attention of the
Associate Dean for GME within two weeks following the failure to resolve the issue at the
department level. The Associate Dean for GME will seek to resolve the issue and may at his/her
discretion seek advice from other members of the faculty, house staff, or staff as deemed
appropriate.
After such evaluation and/or consultation the Associate Dean for GME will make a decision. If the
resident disagrees with the decision of the Associate Dean for GME, he/she must, within 14 days
after receipt of the Director of GME’s decision, notify in writing, the Director of GME, who will
then direct the chair of the GMEC to convene the Review Committee (as defined in IV.C.1.f) to
address the appeal. The Review Committee will meet within 14 days after receipt of the written
appeal. Any member of the Review Committee (faculty or house staff) who has a potential conflict
of interest, as determined by the Chair of the Review Committee will not be permitted to vote.
Likewise, if there is a potential conflict of interest between the chair and the appealing resident, the
Review Committee will elect a temporary chair of the Review Committee for the purpose of the
review. Neither party will have legal counsel present during the Review Committee’s deliberations.
The Review Committee will make a recommendation to the Dean of the Medical School, who will
then make the final decision.
APPROVED BY THE MEDICAL CENTER MEDICAL BOARD 3/26/1998
REVISIONS REVIEWED AND APPROVED BY GMEC: 03/14/2008
Revisions Reviewed and Approved by Medical Center Medical Board: 04/17/2008
BENEFITS
HOUSESTAFF STIPEND
VANDERBILT UNIVERSITY MEDICAL CENTER HOUSE STAFF BENEFITS OUTLINE
For information on the above, please see the links below
http://hr.vanderbilt.edu/benefits/documents/2012BenefitsOverview.pdf
http://www.mc.vanderbilt.edu/documents/gme/files/Benefits%20Outline%20f
or%20Recruits.pdf
http://hr.vanderbilt.edu/benefits/benefitspackage.php
Vanderbilt University Medical Center
2011 – 2012 House Staff Stipends
PGY
Level
Stipend
Amount
Monthly
Stipend
1
$48,198.00
$4,016.50
2
$49,644.00
$4,137.00
3
$51,878.00
$4,323.16
4
$54,213.00
$4,517.75
5
$56,652.00
$4,721.00
6
$59,202.00
$4,933.50
7
$61,866.00
$5,155.50
8
$64,650.00
$5,387.50
9
$67,559.00
$5,629.91
ACGME PROGRAM REQUIREMENTS FOR
GRADUATE MEDICAL EDUCATION
IN NEUROTOLOGY
http://www.acgme.org/acWebsite/downloads/RRC_progReq/286_Neurotolo
gy_Otolaryngology_07012007.pdf
Page 58 of 60
DEFINITIONS OF THE 3 LEVELS
OF RESIDENT INVOLVEMENT
IN SURGICAL PROCEDURES
http://www.acgme.org/acWebsite/RRC_280/280_sur
geonDef.pdf
Page 59 of 60
CASE ENTRY FOR OTOLARYNGOLOGY
AND ALL SUBSPECIALTIES
http://www.acgme.org/residentdatacollection/docum
entation/NewCaseLogInterface.pdf
http://www.acgme.org/residentdatacollection/docum
entation/Manuals/Case_Entry_280_286_288.pdf
Page 60 of 60