Stanford OHNS 2024-25 Resident Handbook by stanfordohns

RESIDENTHANDBOOK 2024-2025

STANFORDUNIVERSITY

SCHOOLOFMEDICINE

DepartmentofOtolaryngology Head&NeckSurgery

1. Introduction

TheStanfordDepartmentofOtolaryngology Head&NeckSurgeryisdedicatedtoproviding thehighestleveloftrainingto itsresidentsandfellows.

MISSIONANDPHILOSOPHY

• Providepatientcarewithbothexpertiseandcompassion

• Fosterdedicationtolife-longlearningandteaching

• Excelatstate-of-theartmedicalcareforpatientswithotolaryngologicaldiseases

• Takeaninvestigativeapproachtothescientificandpolicyquestionsinmedicine

• Inventnewapproachestodiagnosisandtherapy

• Implementandoptimizeemergingtechnologies

• Beactiveworldcitizensintheprovisionofhealthcaretothosemostinneed

ThishandbookdescribespoliciesandproceduresassociatedwiththeOtolaryngology Head &NeckSurgeryresidency,aswellastheexpectationsforsuccessfulcompletionofthe program.Itisupdatedannually.

TheGraduateMedicalEducationOffice’sHouse StaffHandbookisavailablefordownload at: https://med.stanford.edu/gme/policy.html

2. StanfordUniversityOtolaryngologyFacultyRoster

DepartmentChair

ViceChair

ResidencyProgramDirector

AssociateProgramDirector

Stanford

KonstantinaM.Stankovic,MD,PhD

PeterHwang,MD

C.KwangSung,MD,M.S.

JenniferAlyono,MD,M.S.

IramAhmad,MD,MME

NoelAyoub,MD,MBA

FredBaik,MD

KarthikBalakrishnan, MD,MPH

NikolasH.Blevins,MD

RobsonCapasso,MD

KayW.Chang,MD

MichaelChang,MD

AlanCheng,MD

MichelleChen,MD,MHS

EdwardJ.Damrose, MD

SethDavis,MD

ElizabethDiRenzo,PhD

VasuDivi,MD

AndreyFinegersh,MD,PhD

MatthewFitzgerald, PhD

NicolasGrillet,PhD

StefanHeller,PhD

FloydChristopherHolsinger, MD

PeterH.Hwang,MD

RobertK.Jackler, MD

MichaelJ.Kaplan,MD

GraceKim,MD

PeterJ.Koltai,MD

JakeLee,MD

JenniferLee,MD

WilliamLewis,MD

DáibhidÓMaoiléidigh,PhD,MS

PedroMartinsGomesdeOliveira,MD

KaraMeister,MD

UchechukwuMegwalu,MD,MPH

LloydMinor,MD

SamP.Most,MD

JayakarNayak,MD,PhD

TeresaNicolson,PhD

BrianNuyen,MD

LisaOrloff,MD

ZaraPatel,MD

Jon-PaulPepper,MD

NathanReticker-Flynn,PhD,S.M.

AnthonyRicci,PhD

GeorgeShorago,MD

DouglasSidell,MD

DavudSirjani,MD

HeatherStarmer,MA

KristenSteenerson,MD

JohnSunwoo,MD

TristanTham,MD

MaiThyTruong,MD

TulioValdez,MD,MSc

MikeYao,MD

Fellows&ClinicalInstructors

Pediatrics–DanielPenarandaGarcia,MD,MSc &JacquelineHarris,MD

FacialPlastic–ElizabethLongino,MD

Laryngology–MichaelMontalbaron,MD

Rhinology–LiritLevi,MD,DavidLui,MD,PhD&AxelRenteria,MD,MSc

Sleep–YousifAl-Ammar,MBBS,MSc

Head&Neck–KristenKraimer,MD,KatieSpeilbauer,MD &GuolanLu,MD,PhD

Otology-Neurotology–TracyCheng,MD,MHSc &LukasLandegger,MD,PhD

Research- Nesrine Benkafadar, PhD, Marie Kubota, MD, PhD, Shefin Sam George, PhD & Maggie Matern, PhD

AffiliatedFaculty

SantaClaraValleyMedicalCenter

M.LaurenLalakea,MD(Sectionchief)

KimberlyShepard, MD

MicahSaste,MD

AmandaMuñoz,MD

MishaAmoils,MD

JuliaNoel,MD

VeteransAdministrationPaloAlto

DavudSirjani,MD(Chief)

MichellChen,MD,MHS

AndreyFinegersh,MD,PhD

ElizabethLongino,MD

JayakarNayak,MD,PhD

BohdanMakarewycz,MD

HamedSajjadi,MD

C.KwangSung,MD,MS

KaiserPermanenteSantaClara

AliceChang,MD (Chief)

ToddDray,MD

ChristopherGouveia,MD

BrianHondorp,MD

ScottHong,MD

HarryHwang,MD

DongLee,MD

JonathanLin,MD,MBA

CaitlinPacheco,MD

SethPross,MD

AliRezaee,MD

3. OtolaryngologyResidencyApplicationRequirements

• TheStanfordDepartmentofOtolaryngology Head&NeckSurgerywelcomes qualifiedapplicantsforconsiderationforappointmenttoitsACGME-accredited residencyprogram.Pleaseseethe“Residenteligibility –recruitment”sectionof theStanfordHouseStaffPolicies&Proceduresfordetailsofeligibility.The departmentencouragesresidencyapplicationsfromallqualifiedindividuals regardlessofage,sex,ethnicbackground,religiousbeliefs,orsexualorientation withaninterestandaproventrackrecordofexcellenceinscholarlypursuits.

• StanfordparticipatesintheElectronicResidencyApplicationService(ERAS) for otolaryngology.Ranklistsaresubmittedbyboththeprogramandtheresident applicants,andamatchingalgorithmisapplied.

• AllapplicationsreceivedbyStanfordareindividuallyreviewed.Candidatesare selectedforinterviewsbasedonthisinitialreview. Onceinterviewsare conducted,decisionsaboutcandidateselectionaremadebyconsensusamong thefaculty. Approximately45invitationsforinterviewsareofferedfromamong morethan300applications.InterviewstakeplaceontwodaysinJanuary.

4. ResidentRotationSchedule

Key:

Scalpel: HeadandNeckSurgery

Scope: Specialties(Otology,Rhinology,FacialPlasticSurgery)

HM: Headmirror(Laryngology,SleepSurgery,ComprehensiveOtolaryngology)

Peds: PediatricOtolaryngology

NF: NightFloat

SCVMC: OtolaryngologydepartmentatSantaClaraValleyMedical Center

VA: OtolaryngologydepartmentatVeteransAffairsPaloAlto HealthCareSystem

KP: KaiserPermanenteSantaClara

MF: MiniFellowship

Elective: Optionsforresearch,rotatingonsub-specialties, orextra-departmentalrotation

Rad/Res: Radiology(neuroradiology)/Research

Anes*: Anesthesia,StanfordHealthCare

ED*: EmergencyDepartment,StanfordHealthCare

Plastics*: PlasticSurgery,StanfordHealthCare

SICU* StanfordHealthCareIntensiveCareUnit

SCVGS*: GeneralSurgery,SantaClaraValleyMedicalCenter

VAGS*: GeneralSurgery,VeteransAdministrationPaloAlto

*PGY1rotationswithGeneralSurgeryDepartment

2024-25OHNSResidentsRotationSchedule

5. PolicyonResidentPromotion

Stanfordisfortunatetoattractthe highestcaliberofresidentsinthenation.Itisexpected thateachresidenthasthenecessaryskillsandintellecttobepromotedthroughtheresidency andgraduatesuccessfully.Priortocompletionoftheprogram,otolaryngologyresidentsare expectedtodemonstratecompetenceinpatientcare,medicalknowledge,professionalism, system-basedpractice,practice-basedlearningandimprovement,andinterpersonaland communicationskills. Theyarelikewiseexpectedtocompleteandexcelintheresearch requirementsoftheprogram.

Twiceayear,theprogramdirectorconductsameetingwitheachresidenttodiscussresident performanceandeducationaldevelopment. Atthesemeetings,evaluationsoftheresident (thathavebeencompletedbytheresident,faculty,nurses/adjunctpersonnel,andpatients) arediscussedatlength. Attendancerecordatconferences,residentresearchprojects, operativelogs,andplanned/completedportfolioprojectswillbereviewed.

6. PolicyonResidentDismissal

Residentsareexpectedtosatisfyatleastaminimumlevelofcompetenceinordertobe promoted.

Residentsfailingtoachievetheminimallevelofcompetenceasdeterminedbythe evaluationswillbegivenwrittennoticeofthatfact.Dependingonthenatureofthe deficiency,theymaythenbeplacedonprobation.Thisperiodofprobationwilllastat least threemonthsandwillbeaccompaniedbyadetailedplantoaddressanydeficienciesinthe resident’sperformance.

Residentswhoareonprobationforaminimumofthreemonthsandwhohavenot successfullyimprovedtheirperformancetomeetatleasttheminimallevelofcompetence maybedismissed.

7. 360°Evaluations

Performanceevaluationsarecompletedbyvariousmembersofthehealthcareteam includingfaculty,staff(nurses,MAs,physicians’assistants,nursepractitioners,technicians, anesthesiologists,etc),patientsandpeers. Theseevaluationsaddressperformanceinthe corecompetenciesandaresenttoevaluatorsaftereveryrotation,includingtheresearch block.Evaluationsareconductedon-lineviatheMedHub systemtoassureanonymity.Inan efforttoobtaina360-degreeevaluation,patientsarealsorandomlyaskedtocompete evaluationsbasedontheirinteractionswithresidents.

Peerevaluationsareheldfromresident-accessuntiltheendoftheyeartoprotectanonymity. However,atthesemi-annualreviewmeeting,theprogramdirectorwillshareaggregated feedbackoftheseevaluationsverbally. Resident(s)withthehighestpeer ratingsfor outstandingteachingwillbeawardedthe“ResidentTeacheroftheYear”awardattheendof theyear.Anawardwillalsobegivenfortheresidentratedhighestasanoutstandingteam playerbytheirpeers.

Meaningfulevaluationofthefacultyandthe programisacriticalaspectoftheresidency program;itisatoolforimprovingeducationalqualityandtheresidentlearningenvironment. Residentsarethereforeexpectedtocompletefacultyandrotationevaluationsinatimely fashionaftertheendofeachrotation.

Residentswillhaveaccesstotheirevaluationsbyfacultyuponcompletionoftheir faculty/rotationevaluations. Toassureanonymity, theevaluationsoffacultyandrotations willnotbecollatedormadeavailabletofacultyuntiltheendoftheacademic year. Evaluationsbyresidentsarealwaysanonymous.

8. PolicyonSupervision

SeeGMEhandbookforpolicies.

StanfordOHNS SystemTriggersforAttendingCommunication

• Admission/discharge

• Transferin/outofICU

• Unplannedintubation

• Cardiacarrestorhemodynamicinstability

• Neurologicalchanges

• Woundcomplications

• Anymedicationortherapeuticerrorthatleadstoachangeinpatientmanagement

• Unplannedtransfusion

• Anyclinicalproblemrequiringaninvasiveprocedure

• ERvisit

• Anyconcernbyatraineethatasituationismorecomplicatedthanheorshecan manage

• Anyrequestthatanattendingsurgeonbecontacted

• Anysituationinwhichaparentrequestsattendingnotificationorfeelsthatanissue hasnotbeenadequatelyresolvedoraddressed

• Anynewonset/worseningofsymptomsoutofproportiontoexpectations

9. MentorshipProgram

Residentsareassignedtocohortsoffivetosixresidentsrepresentingeachpost-graduate year,andthesecohortsareassignedtoonefacultymember.Inaddition,atthebeginningof thePGY2year,residentswillbeassigneda1:1mentor.

Thementorshipcohortswillmeetatleastthreetimesayearforactivities(egdinner,outings) withtheirmentors.

Thegoalsofthisprogram aretoencouragemoreroutineinteractions,developclosergroup dynamicsandfriendships,andfostersupportive socialandprofessionalnetworks.

Theresidentmayconsultthe cohortfacultymentor or1:1mentor asneededonanyissues eitherprofessionalorpersonal.TheresidentshouldalsofeelfreetoconsulttheProgram Directorregardinganysuchsubjects.

Thefacultymentorswillfunctionasliaisonstotherestofthefacultyforissues regarding residentacademic,clinicalandoperative performanceaswellaswell-being.

ResidentMentors

Theotolaryngologypeer-mentoringprogramwasstartedin2009toprovideaformalized careerandpersonalsupportsystemtojuniorresidents.Incominginternsarepairedwith midlevelresidents,basedonconsiderationoftheircommoninterests. Seniorresidentshavean opportunitytoofferprofessionalguidance,moralsupport,processdecisionsandthelike. Notificationsofthesepairingsaremadeinthespringpriortoincominginterns’arrivalto Stanford.

Classbeginning2023

MonicaBodd -MichaelBelsky

PeterMoon-RamiEzzibdeh

VarunSagi-StevenLosorelli

AmarSheth-PatrickKiessling

ShannonWu-ArifeenRahman

Classbeginning2024

LekhaYesantharao-ShaynaCooperman

UchechukwuEzeh-MaxwellLee

BrookeWarren-LaceyNelson

DavidGrimm-ElishMahajan

MichaeleFrancescoCorbisiero -AnthonyThai

10. AcademicCurriculum

RequiredAssignments

Thefollowingisalistoftheprinciplerequiredprojectsandtalksduringthecourseofthe residency:

Allfiveyearsofresidency

❑ OtolaryngologyIn-trainingExam

❑ Temporalbonelab

PGY1

❑ RadiologycasepresentationassembledduringRadiology/ResearchRotation

PGY2

❑ Researchproposal,dueatsemi-annualmeetingwithprogramdirectorin January/February.

❑ ResidencyResearchSymposiumPresentation

❑ RadiologycasepresentationforResidentEducation

PGY3

❑ ResidencyResearchSymposium Presentation

❑ AbstractsubmissiontotheBayAreaResidencyResearchSymposium

❑ QualityImprovementProject

PGY4

❑ ResidencyResearchSymposiumPresentation

PGY5

❑ GrandRounds

❑ ResidencyResearchSymposiumPresentation

11. DescriptionofAcademic Content,Conferencesand Responsibilities

AsofJuly2024,theacademiccurriculum ontheAmericanAcademyofOtolaryngology–Head &NeckSurgery’sOtolaryngologyCoreCurriculum,astandardizedtwo-yearcurriculumthat willallow eachresidenttobeexposedtoeachtopicatleasttwiceduring theirresidency. WeeklyResidencyEducationconferencesareheldon Mondays8:00-10:00AM. Residentsare expectedtobeontimefor 75%ofsessions(exceptforcasesofpre-approvedexcused absences).ResidentsatSCVMCandVAPAwillbeexpectedtoparticipate inpersonwhen possible,or viaZoomvideoconference whennecessary.Attendancerecordswillbe tracked andwillbereviewedbyresidentsandfaculty.

AlsoonMondaymornings,GrandRoundsandQualityImprovementbeginat 7:00AM. In addition,therewillbeatleastonebookclub,andjournalclubsareheldonweekdayevenings fourtimesayear. Residentswillbeassignedtohelporganizethejournalclubs. Residentsare expectedtopracticedrillinginthetemporalbonelabontheirowntomeetrequired competencies. Seeappendix(TemporalBoneLab)formoreinformation. TheQuality ImprovementCurriculum,whichincorporatesayear-longgroupprojectisarequirementof allresidentsintheirPG3year.

TheuseoflaptopsisnotpermittedduringGrandRounds.

ThePGY5chiefresidentswillbeassignedtogiveonegrandroundssessionduringtheyear. Thetopicisofthechiefresident’schoosing,butthepresentationisexpected

AllresidentsontheScalpelServicearerequiredtoattendtheHead&NeckResidentCase ConferenceeveryThursday4:00-4:30PM,followedbyHead&NeckTumorBoard4:30-5:00 PM.

Allresidentsarerequiredtocompleteanallergycourseeitheronlineorinpersonatsome pointduringtheirresidency.Inaddition,allresidentsmustspendaminimumof twohalfdaysintheAllergyClinictogainhands-onexperiencewithskintesting. ContactDr.Meng Chenatmengchen@stanford.eduatleastonemonthinadvancetoscheduleyourclinictime. TheserequirementscanbecompletedinanyPGYyear. Duetotravelrestrictions,the requirementsmaybecompletedonlinethroughtheWorldAllergyOrganizationwebsite: https://www.pathlms.com/wao/

Thefollowingallergysessionsshouldbecompleted:

https://www.pathlms.com/wao/courses/585

https://www.pathlms.com/wao/courses/4114

https://www.pathlms.com/wao/courses/1771

https://www.pathlms.com/wao/courses/572

https://www.pathlms.com/wao/courses/586

https://www.pathlms.com/wao/courses/576

https://www.pathlms.com/wao/courses/581

Allresidentsarerequiredtotakethein-trainingexameachyearofresidency,heldthefirst SaturdayofeachMarch,includingresidentsintheirdedicatedresearchyearsofthe CSTP track.

AttendancePolicy

Conferences

Attendancewillbetakenateachofthe Mondayconferencesat8:00AM,otherrequired conferences(egjournalclub,grandrounds,etc),andotherevents(residencymeetings, symposium,etc).

MandatoryEvents

Residentsarerequiredtobepresentforthefollowingannualevents.Vacationtimeshouldbe scheduledaccordingly:

• Residencygraduation

• ResidencyResearchSymposium

• In-trainingexam(firstSaturdayofMarch)

• ResidencyAnnualProgramEvaluation/Retreat(firstMondayinJune)

AnnualIn-trainingExam

Allresidents,includingthePGY1residents,includingresidentsintheirdedicatedresearch yearsoftheCSTPtrack,arerequiredtositforthein-trainingexam,administeredthefirst SaturdayofMarch. Residentswhoachievescoresinthe7th-9th groupstanineswillreceive a prizeof$500foracademicpurposes.Thoseinthebottomthreestanineswillberequiredto submitawrittenstudyplantotheprogramdirectorandtheirassignedmentor,andtomeet withtheirmentoronaquarterlybasistodiscussprogress.

ResidencyResearchSymposium

Everyyear,ongraduationFriday,thedepartmenthostsaday-longsymposiumtoshowcase researchconductedbyresidentsovertheyear. PGY2-5arerequiredtogiveapresentation. Maximumtimeforthepresentationis7minutes(withanadditionalthreeminutesof questionandanswertime).Presentationsarejudgedbyselectedfacultyandtheguestof honorusingacriterion-basedrubric.Agrandprizeof$500inacademicfundsisgiventothe bestoverallpresenter;therearetworunnersup,receiving$250inacademicfundseachinthe categoriesofpresentationandcontent,respectively.

Tobeeligiblefortheseprizes,thematerialpresentedmustconstitute originalresearch conductedbytheresident(whichhasalsonotbeenpreviouslypresentedinyearspast,but mayhavebeenpresentedatanationalconferenceortheBayAreaResidencyResearch Symposium). Anabstractofthetalkisduetwoweeksbeforethesymposiumdate.

QualityImprovement(QI) Curriculum

EffectiveJuly1,2020,theQIcurriculumhasbeenrevamped. While itspurposeremainsthe same,thislearningrequirementhasbeenrestructured,isnowbeingoverseenbyDr.Lalakea, andisacollectiveratherthanindividualresidentprojectofPGY3’s.

TheaimoftheQIprojectistodevelopaplantosupportahospitalorclinicalperformance improvementorpatientsafetymeasureby:

• Reflectingonpracticeandpracticeanalysis

• Criticallyanalyzingthecurrentliterature

• Developingaplanforimplementationoftheproposedchange

• Developinganoutcomes’assessment(performancemeasure)

Itsoverallpurposeis tofosteranunderstandingofthecomplexitiesofhealthcaredelivery anddeveloptheskillstoaddressthemasisdescribedbythecorecompetency,SystemsBasedPractice.

Theprogramisillustratedintheimagebelow. Workingsessionswilltakeplaceonweekday evening,fourtimesayearbetweenJulyandOctober. Thereaftertheteamwillmeetonits ownforcompletionoftheprojectinthefollowingJune.

NationalAcademicConferences

EveryattemptwillbemadetorelievethePGY2orPGY3residentsfromtheirclinicaldutiesso thattheymayattendtheCombinedOtolaryngologySpringMeetingsponsoredbythe Departmentonetime.

Inaddition,allresidentswhohaveabstractsacceptedfor podiumpresentationataregional ornationalmeetingwillberelievedoftheirclinicalresponsibilitiestoattendthemeetingand presenttheirdata.PGY1-3’swhohaveabstractsacceptedforposterpresentationata regionalornationalmeetingwillberelievedoftheirclinicalresponsibilities,ifpossible,to attendthemeeting.Theywillbeeligibletoreceivefundingtooffsetthecostsofthemeeting (currentlysetatamaximumof$1,400per domesticconference,and$1,600perinternational conference).Thereisnomaximumonthenumberofconferencesaresidentmayattend.See PolicyonResidentTravel.

FellowshipInterviews

Manyotolaryngologyresidentspursuefellowshipsinotolaryngologysubspecialtiesaftertheir residency.Thefacultyrecognizesthatresidentsneedtointerviewforthesefellowshipsand willmakeeveryefforttoreleaseresidentsfromtheirclinicaldutiessothattheymayattend theseinterviews. Fellowshipapplicantsareaskedtotrytominimizethedaysawayfromtheir rotationastheirabsenceplacesanundueburdenontheirfellowresidents.

12. ResidentTravelandConferenceFundingPolicy

Note:CheckthelatestupdatesonUniversity-sponsored travel.

Residenttraveltothefollowingscientificmeetingswillgenerallybeapprovedfor departmentalsupport:AmericanAssociationforResearchinOtolaryngology(ARO), CombinedOtolaryngologicalSpringMeetings(COSM),AmericanAcademyofOtolaryngologyHead&NeckSurgeryAnnualMeeting(AAO-HNS),andSectionMeetingsoftheTriological Society.Traveltoothermeetingsmaybeapprovedonacase-by-casebasisbytheprogram director.

Inaddition,fundingapprovalwillrequirethatthefollowingthreecircumstancesexist:

Theresidentmustbethepodiumspeaker,courselecturer,orposterpresenter. Poster presentationsaregenerallyacceptableonlyforPGY1-3residents(atthetimeofthe presentation).IfaposterofaPGY4-PGY5residentisacceptedtheresidentmaybeeligiblefor travelfundingbutthismustbeapprovedbytheprogramdirectoraheadoftime.However, postersonlaboratorybasicsciencetopicsareacceptableatanytraininglevel.

Inaddition,theworkmustbeoriginalandpresentedforthefirsttime and,thepresentation mustbeaccompaniedbyamanuscriptthatissubmittedtoa peerreviewedjournalbefore thetimeofthemeeting.

MajorExpenseGuidelines (Residentsarehighlyrecommendedtobooktheirtravel, includingflightandhotel(withexceptions),through theStanfordTravelprogram for sponsoredtrips):

Bookingtravel

Registertravelviatheitinerary forwardingservice

Flightand hotel Required (UnlessbookedthroughStanford Traveorconferencehotel)

Bookthroughoneofthe Stanford Travelbookingchannels

Highlyencouragedbecauseof automaticregistrationofitinerary aswellas anychangestotheitinerary

Carrental Notrequired Recommended

§ Roundtripairfarewillbereimbursedatthelowestavailablefare.Residentsareencouraged topurchasethroughEgenciaorotherStanfordTravelchannels: https://stanfordtravel.stanford.edu/ (usingyourSUNetIDandpw).

§ HotellodgingshouldalsobeeitherbookedthroughEgencia(exceptforconferencehotels) orusetheitinerary-forwardingservice ifnotbookedthroughtheStanfordTravel program.

Regardlessofthemodeofbookinghotels,travelersmustcontinuetoadhereto Stanford’slodgingpolicy.

§ Meetingregistrationreimbursementwillbebasedonearlypre-registration,notat-thedoorfees.

§ Allgroundtransportationreimbursementisbasedonactualexpensesandshouldbe reasonableand necessary.PerAGM5.4.2,itisrecommendedtouseStanfordTraveltobook rentalcars.

§ Mealswillnotbereimbursed.

§ Totaldepartmentalreimbursementforagivenmeetingwillbea maximumof$1,400per domestictrip,and$1,600perinternationaltrip

§ Posterexpensesarereimbursedupto$200. Thisisconsideredseparatefromthetravel expenses.

NOTE:Theultimateapprovalofallresidenttravelatdepartmentalexpenseisatthe discretionoftheprogramdirectoranddepartmentalchair.Approvalofreimbursementfor travelnotmeetingtheabovecriteriamaybepossibleundercertaincircumstances andwillbe evaluatedonacase-by-casebasis.

13. PersonalTime-off

Housestaffarepermittedtotakeupto fourweeksofpersonaltimeoffwithpayduringeach one-yearperiod. Vacationshouldbescheduledin1-weekblocksunlesspriorapprovalis obtainedfromtheprogramdirectorandtherotationdirector(forexampleif2weeksare requestedtogetherorifapartialweekisrequested). Personaltimeoffmustberequested andsubsequentlyapprovedthroughtheMedHubsystem. StanfordUniversityMedicalCenter believesthatpersonaltimeawayfromtheresidencyprogramisimportanttothewelfareof housestaff,sounusedpersonaltimeoffdoesnotaccumulatefromyeartoyearandthereis noprovisiontopayinlieuoftimeoff.

Residentsshouldnotplanontakingvacationatthetimeofthein-trainingexam,duringthe timeoftheAnnualProgramEvaluation (ResidencyRetreat),orduringtheweekofthechief residents’graduationdinnerandtheannualResidentResearchSymposium.Ataminimum, rotationdirectorsandthePDshouldbenotifiednolessthan2weeksbeforetherotation starts. AlltimeoffmustberecordedinMedHub.

So-called“terminalleave,”vacationasthefinalweekofresidency,willbeconsideredonan individualbasisforresidentswhowillbepursuingafellowship. Aresidentwhoistaking terminalleaveshouldnottakeanadditionalweekofvacationduringthesamerotation block.

Timeoffforfellowship/jobinterviews

Residentsarenotpermittedtotakevacationinanyquarterinwhichtheywillbegonefor morethanfivedaysduetointerviews,unlesstheyareusingvacationtimetointerview. Residentsmustreportthenumberofdaystheywillbetakingofftotheprogramdirector. To avoidpatientcarecoverageissues,PGY2’sshouldtrynottakevacationwhenaresidenton thesamerotationisinterviewing.

14. ResidentWorkHoursandCall

TheDepartmentofOtolaryngology Head&NeckSurgeryiscommittedtofollowingthe currentACGMEpoliciesondutyhours.SeeGMEhandbookforpolicy.

Theresidentcallschedulewillbedeterminedbythechiefresidents onScopeandVAPA. First callissharedamongjuniorresidents;thesecondcallisbythechiefresident orPGY4.Third callisstaffedbyafacultymember.Recognizingtheindividualresidentcircumstancesand needsandacknowledgingtheautonomyofthespecificsiteswithintheresidencyprogram,it isunderstoodthattheresidentswillbeallowedtodeterminetheirowncallschedule,tothe extentthatthisdoesnotcreateanyunduehardshipforanyindividualresidentanditfollows theaboveguidelines.Asmuchaspossible,noresidentshouldbeoncall2weekendsinarow. Residentworkhoursaremonitoredonaweeklybasisandanypotentialissuesareaddressed immediately.

Thefollowingguidelineswereadopted startingthe2020-2021AcademicYeartoaddressduty hourconcerns:

AllResidents:

• Alldayresidentsshouldleavethehospitalby9:00pmweekdays.Residentsmay voluntarilyelecttostay(ifworkingwithin80hours/week,1in7daysoffguidelines):

– tocontinuetoprovidecaretoasingleseverelyillorunstablepatient

– humanisticattentiontotheneedsofapatientorfamily

– toattenduniqueeducationalevents

• Thenightfloatresidentshouldactivelytakeoverdayresidents’work(e.g.,intheOR) toallowthemtoleaveby9:00pm,iftherearenoactiveconsults.

• Theattendingorfellow aretodictatecaseswhenfinishingafter9:00pmwhentheday residenthasleft.

JuniorResidents

• Chiefsmayallowjuniorresidentsoncallfortheweekend(PGY2–4)toskipmorning roundsduringtheweek.

– Theseresidentsshouldalsoleavethehospitaleachdayassoonastheirclinical responsibilitiesarecompleted.

• PedsWeekendRounds:Thepost-callresidentroundingmustleavethehospitalby 10:00amtofinishtheirshiftwithinthe24hours+4hoursoftransitiontimeguidelines.

– TheSHCjuniorresidentorchiefshouldtakeoveranyremainingworktoallow fortheresidenttoleaveontime.

– Attendingonweekendcallmustroundnolaterthan8:00am.

Interns

• SHCinternonfortheweekendcanworkamaximumof14.5hours/weekdayand7 hours/weekendday(6:00am–1:00pm)(86.5hourstotal.Thiswillbebalancedoutby weekswheretheyarenotoncalltoremainunderthe80hour/weekaverage).

• LPCHinterncanworkamaximumof14.5hours/weekdayand7hoursonSaturday (6:00am–1:00pm)(79.5hourstotal).

– LPCHinternisoneverySaturdayduringtherotation.

• Chiefsshouldensurethesehoursareadheredtobyschedulingclinicalresponsibilities accordinglyandreleasinginternsby7:30pmevenifPMroundshavenotbeen completed.

Valley/VANightandWeekendCall

• Full-timeresearchresidentswilltake1weekendofcallpermonth.Theymayalsotake upto1weeknightcallontheotherweeks.

• PGY4sonresearchtimemaytake1weeknightcallperweek

– Whentherearenofull-timePGY3residents,thePGY4onresearchwillfollow thecallscheduleforfull-timeresearchresidents.

• Frequencyofweeknightcallforresearchresidentsmayvarydependingonthe numberofresidentsonresearchatonetime.

On-callroomsareprovided.

AllresidentsarerequiredtoentertheirworkhoursintotheMedHubsystemonatleasta weeklybasis.

15. DepartmentalHand-overPolicy

Whenon-call,residentstypicallycoverpatientsatmorethanonehospital. Forthisreason,a verbalcheck-outprocedureviaphoneiscurrentlyusedbytheresidentstaff. Elementsofthis policyinclude:

Priortoleavingthehospitaleachday:

• Juniorresidentscheck-outtoon-calljuniorresidentortonightfloatresidentevery patientviaI-PASS(I:Illnessseverity;P:Patientsummary;A:Actionitems;S:Situation awarenessandcontingencyplanning;S:Synthesisbyreceiver).

• Aftercheckingout,theJuniorresident(s)withtheghostconsultandfloorpagerswill reassignthepagerstotheon-callresident. Inthemorningtheresidentassumingthe

consultpagerwillreassigntheghostpager,andeachresidentcoveringthefloorghost pagerswillreassignthepagers.

• Senior/chiefresidentscheckouttosenior/chiefresidentsregardingall unstable/concerningpatients.

• Facultymemberscheckoutallconcerningpatientstofacultymemberoncall.

16. OperativeCaseLogs

AllresidentsarerequiredtoenterdataontheirsurgicalcasesintotheACGMEsystemina timelymanner(everyweekrecommended,operativelogsmustbeup-to-dateatthetimeof thesemi-annualresidentmeetingwiththeprogramdirector orassociateprogramdirector.)

Residentsareresponsibleforkeepingtrackofthesurgicalcasesinwhichtheyparticipate.

AResidentSupervisorinstructs,andassistsasneeded,amorejuniorresidentduringa procedureduringwhichthejuniorresidentperformsgreaterthanorequalto50%ofthe operation,includingthekeyportion(s)oftheprocedure. Theattendingfunctionsasan assistantorobserver.

AResidentSurgeonperformsgreaterthanorequalto50%oftheoperationwiththe attendingsurgeon(andresidentsupervisor,ifapplicable),includingthekeyportion(s)ofthe procedure.

AnAssistantSurgeonperformslessthan50%oftheoperation,orgreaterthanorequalto 50%oftheoperationbutnotthekeyportions(s)oftheprocedure.

ResidentsareresponsibleforenteringalldataintotheACGMEdatabase. Accuracyinthis endeavoriscritical,bothforjustifyingaresident’ssuitabilityforsittingfortheboard examination,aswellasaccuratelyreflectingthevolumeofsurgerydone intheprogram.

TherequiredminimumnumberofkeyindicatorproceduresislistedinAppendixD. Codingguidelinesarelistedat: https://medwiki.stanford.edu/display/ent/Protocols+and+Forms

17. Communication

Addresses:Theresidenthomeaddresses,emailaddresses,homephonenumbersandcell phonenumbersshouldbeprovidedtotheadministrativestaffwithinthedepartmentand updatedonMedhub.

E-mail: ResidentsarerequiredtomaintainanactiveStanforde-mailaddressthatischecked regularly(atleastevery48hours). Allclinicalandacademice-mailshouldbesentthrough thissystem.Alle-mailwithprotectedhealthinformation(PHI)mustbesentsecurely(thisis donebytyping“SECURE:”atthebeginningofthee-mailsubjectline).

18. GuidelinesforOnlineProfessionalorPersonalActivity

TheseguidelinesapplytoStanfordOHNSresidentsinsocialmedicalvenuessuchas professionalsocietyblogs,LinkedIn,Google+,Instagram,Twitter,and/orFacebook,etc.for deliberateprofessionalengagementorcasualconversation.

• ProtectedHealthInformation,includingphotographs,maynotbeplacedonsocial mediasites.

• Forthepurposesofeducation,descriptionsofpatientcasesandclinicalimagesmay bepostedtopasswordprotectedprofessionalsitesoncethedatahasbeendeidentified.

• ByvirtueofidentifyingoneselfasapartofStanfordinsocialmedia,residentsconnect themselvesto,andreflectupon,Stanfordcolleagues,Stanfordpatientsand supporters.

• Rememberthatallcontentcontributedonallplatformsbecomesimmediately searchableandcanbeshared.Thiscontentleavesthecontributingindividual’s controlforever.

19. PolicyandGuidelinesforInteractionswithIndustry

Theabovepolicymaybeaccessedat: https://med.stanford.edu/siip/home.html

Highlightsofthispolicyinclude:

1) Medicalstaff,faculty,students,andtraineesmaynotacceptgiftsfromIndustry anywhereattheStanfordSOM,SHC,LPCH,orotherclinicalfacilitiesoperatedbyeither hospital. ItisstronglyadvisedthatnoformofpersonalgiftfromIndustrybe acceptedunder anycircumstances.

2) FreedrugsamplesgivendirectlytomembersoftheSUMCareconsideredgiftsand maynotbeaccepted,exceptbythepharmacyforuseforneedypatients.

3)Giftsorcompensationmaynotbeaccepteda)atanyStanfordornon-Stanford facilitysuchasotherhospitalsandoutreachclinics,b)forlisteningtoasalestalkbyan industryrepresentative,c)forprescribingorchangingapatient’sprescription, d)forsimply attendingaCMEorotheractivityorconference,includingthedefrayingofcosts.

4) MealsorothertypesoffooddirectlyfundedbyIndustrymaynotbeprovidedat StanfordSOM,SHC,LPCH,orMenloClinic.

5) Salesandmarketingrepresentativesarenotpermittedinanypatientcareareas excepttoprovidein-servicetrainingondevicesandotherequipmentandthenonlyby appointment. Theyarepermittedinnon-patientcareareasbyappointmentonly.

6) IndustrysupportofstudentsandtraineesintheSOMeducationalprogramsshould befreeofanyactualorperceivedconflictofinterest,mustbespecificallyforthepurposeof educationandmustcomplywithseveralprovisions:a)TheDepartmentselectsthestudentor trainee,b)ThefundsareprovidedtotheSchool,department,program,division,orinstitute andnotdirectlytothestudentortraineeortoanindividualfacultymember;c)The department,program,division,orinstitutehasdeterminedthatthefundedconferenceor programhaseducationalmerit,d)therecipientisnotsubjecttoanyimplicitorexplicit expectationofprovidingsomethinginreturnforthesupport.

SOMfaculty,students,staffandtraineesshouldevaluatecarefullytheirattendanceat meetingsandconferencesthatarefullyorpartiallysponsoredorrunbyIndustrybecauseof thepotentialforperceivedorrealconflictofinterest.

20. StanfordDepartmentofOHNSGuidelinesforConsultations

Generalguidelinesforallconsults:

◼ Otolaryngologyisaserviceorientedspecialtywhererelationshipswithpractitionersof otherservicesareestablishedandmaintained.

◼ ALLconsultsshouldbeseenthedaytheyarereceivedunlessitislateinthedayand thereferringproviderexpresslystatesthatitisfinetoseethenextday. Iftheconsult isreceivedbutnotseenonthatday,pleaseseetheconsultyourselfonthefollowing daysoanotherresidentisnotleftwithyourwork.

◼ Ifaconsultisreceivedandyouthinkitistrulyaninappropriateconsult,anOHNSChief ResidentMUSThearabouttheconsultandgivepermissionfortheOHNSresidentto notseetheconsult.

◼ ConsultstakepriorityovertheOR.

◼ Allconsultsmustbestaffedwiththeoncallattendingthedayoftheconsult.

◼ Aconsultnotemustbeenteredonthedayoftheconsult(includingvocalfold consults). Thisincludesanyconsultyousee,evenonesthatareimmediatelysigned offon.

◼ Afullconsultnotemustbeenteredforeveryconsultpatient. ItisnotOKtoonlyenter aprocedurenotewithoutaconsultnote(forexample:afullconsultnoteneedstobe enteredforapatientwithpossiblevocalfoldparalysis –notjustthelaryngoscopy note.)

◼ Duringtheday,theconsultnotemay(andshould)bestartedbutnotcompleted(i.e. don’tputtheassessmentandplan)untiltheconsulthasbeenseen/discussedwiththe attending.

◼ Alloutpatientcallsshouldbereturnedinatimelyfashionandhaveatelephone encounterdocumentedintheappropriateEPIC.

◼ Thenightfloatresidentsshouldseeanddocumentallconsults-evenonesthatarenot urgent.

◼ Referringprovidersshouldbetreatedwithrespect –justaswewanttobetreated whenwecallinaconsult. Inevitably,wewillreceivesomeconsultsforconditionswe thinkare“silly”or“awasteoftime”. Rememberthatwesometimescallinthesetypes ofconsultstoo. Aconsultisarequestforhelp. BENICE.

EmergencyDepartmentConsultations:

◼ Shouldbeseenwithin1hourofreceivingthecall(obviously,quickerforurgent consults)

◼ AlwayscheckoutwiththeEDphysician-don’tleavewithouttalkingtothem.

ConsultsatSHC:

◼ TheConsultPGY2(andoccasionally1)servesasthefront-lineconsultresident.

◼ Consultswillbeaddedtotheteamofthestaffingattending(ieaconsult staffedbyaScopeattendingwillgototheScopeservice.)

◼ Trachconsultswillgototheservice ofthestaffingattending.

◼ Vocalfoldconsultsgotothe Headmirrorservice.

◼ ExistingH&NpatientswithaH&NissuewillgotoScalpelevenifnotyetstaffed withtheH&Nattending(i.e.laryngealtumorpatientfollowedbyKaplaninthe pastbutstaffedwithrhinologyfellowwillgotoH&N)

◼ NewH&Npatientswillgototeamofstaffingattendingunlessdirected otherwisebythechief(i.e.newtongueSCCconsultstaffedbyFPRSfellowwill gotoScopeatfirst.)

◼ Ifyouwantaconsulttobeseeninafellow/instructorclinic(i.e.mandible fracturetobeseeninFPRSclinic)youmustemail,callortextthatattending. A STAFFMESSAGEALONEISNOTSUFFICIENT!

ConsultsatLPCH:

PleaserefertoPedsServiceGuidelinesprovidedbythedivision.

21. OtolaryngologyPost-GraduateEducationalProgram

GoalsandObjectivesPGY1-Non-OHNSrotations

Rotation Contacts and Scheduling Details

RotationDirector:KwangSung,MD,MS kwangs@stanford.edu

NOTE: Allresidents,includingthePGY1 residents,willtakethein-trainingexamonthefirstSaturdayinMarch.

Rotationdetails:

Thedailyscheduleswillbedeterminedbythechiefresidents/facultyoneachindividualrotation. Whileonotherrotationsresidentsshouldattendtheresidenteducationsessionsforthatspecialty.Residentsshouldattend theOHNS educationsessionswhenfeasible.

Radiology/Research/LaryngologyRotation

This rotation is comprised of neuroradiology, audiology, neurology, laryngology, and research.

RotationContacts&Addresses

RotationDirectors:

ShwetaKumar,MD(Neuroradiology) shwetak1@stanford.edu

MattFitzgerald,PhD fitzmb@stanford.edu

Clinics:BesidesStanfordandLPCH,thelocationsforthisrotationinclude:

• 451ShermanAve

• Hoover2Pavilion(SNHC,StanfordNeurosciencesHealthCenter,213QuarryRd)

• VAPA

• StanfordEarInstitute(WatsonCourt)

RotationDetails:

• Oneweekbeforetherotation,residentistotouchbasewithDr. ShwetaKumar(shwetak1@stanford.edu)fororientation planandsharingofdocuments,includingupcomingfaculty/fellowschedulesandconferenceschedules.

• Atleastoneweekbeforetherotation,residentistomakeanappointmentwithDrs.KaraMeister (meister4@stanford.edu)orIramAhmad (ahmadin@stanford.edu),residencyresearchcommitteefaculty,todiscuss researchgoals.

• Oneweekofthefour,theresidentwillbeassignedtotheHeadmirror teamtoallowtheresidenttogainexperiencein flexiblelaryngoscopyintheVoiceandSwallowingClinic.

• Atleasttwohalf-daysaretobespentinneurologyclinic shadowingDr.KristenSteenerson(onMondays,Tuesdays, ThursdaysorFridays).PleasecontactDr.Steenerson(ksteen@stanford.edu)onemonthinadvancetoarrange.

• ResidentswillattendOHNSconferencesonMondaymorningsandneuroradiologyconferences(seelist)asappropriate andaspossible.ThemorningswillgenerallybespentintheneuroradiologyreadingroomsatStanford, 300P,Sherman Aveand/orHoover.

• Oneafternoon(WednesdayorFriday)aweekwillbespentinaudiology,primarilyattheStanfordEarInstituteatWatson Court.

• Afternoonsnotspentinaudiologyorneurologyaretobeutilizedtodevelopresearchplans.

ResidentsarerequiredtocompletetheprojectspecifiedintheG&Os.

Conferences:InadditiontoattendingMondaymorningOHNSconferences, theresidentisencouragedtoattendthefollowing conferences,dependingonappropriatenessofcontent.CurrentschedulescanbeprovidedbyDr. Kumar orbyneuroradiology programcoordinatorMalikaCurry(mcurry18@stanford.edu).

Conference Time Locations

Tuesdays –NeuroradiologyFellows Conference 7:30AM

Tuesdays–NeurosurgerySkullBase Conference 5:30PM

Zoomatpresent(Zoominfoavailable onthemonthlyconferenceschedule)

Tuesday–ThirdTuesdayofmonth (usually):PedsENTRadiologyConference 5-6pm

Wednesday–NeuroradiologyFellows Conference 1:30PM

Thursdays–RadiologyResidentdidactic block Noon-5pm(ifNeurolectures, typicallyat12:30and1:30p.m.)

Thursdays–Head&NeckTumorBoard 4:30-6:30PM

Radiologyreadouts:

LPCHConferenceRoom

Zoomatpresent(Zoominfoavailable onthemonthlyconferenceschedule)

• 8:30amto11amislikelythebesttimeforaconsistentread-outexperience.

• Additionalone-on-oneRadiologyreviewtimeviaZoommightbeavailableduringpreparationoftheTuesdaySkullBase conference(Dr.Fischbein, fischbein@stanford.edu)ortheThursdayHeadandNeckTumorBoard(Dr.Fischbein,Dr. Kumar,orDr.NancyPham,nanpham@stanford.edu)

• Observationofimage-guidedbiopsyproceduresmightalsobepossible –touchbasewithDr.Phamforthisoption.

OtherResources:

• DiagnosticImaging:Head&Neck,3rd EditionbyKoch,etal

• ExpertDifferentialDiagnoses:Head&Neck,byHarnsberger

• FatPadsoftheHeadandNeck:Animagingreview,byPateletal., https://doi.org/10.3174/ng.9170238

• LearningHeadandNeck:https://www.learningheadandneck.com/

Competency-basedGoalsandObjectives

General&PlasticSurgeryrotations: Tobeabletoprovidepre-andpostoperativecaretothesurgicalpatient.

ResidentObjectives: ACGMECompetencyGoals

Beabletotakeadetailedsurgicalhistoryandreviewrelevantmedicalrecords. PatientCare

InterpersonalandCommunicationsSkills

Beabletoperformadetailedphysicalexamination.

PatientCare

MedicalKnowledge

Beabletowrite/dictateathoroughandsuccincthistory&physical.

Understandtheprocessofobtainingasurgicalinformedconsent.

Beabletocompleteathoroughclinicalnoteintheinpatientrecord.

UnderstandNPOguidelines.

Understand fluidmanagementintheNPOpatient.

Understand thebasiclaboratoryandradiologictestsperformedforthepre-operativeand post-operativepatient.

Understand thebasicsofnutritionalsupportforthesurgicalpatient.

Understandoperativesterilityprinciples.

Understand thediagnosisandbasicsofmanagementofsurgicalrelatedinfections.

Understandtheguidelinesanduseofprophylacticantibiotics.

Learnhowtoeffectivelyutilizethe“EPIC”computerizedmedicalrecord.

PatientCare

InterpersonalandCommunicationsSkills

PatientCare

Systems-BasedPractice

InterpersonalandCommunicationsSkills

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice GoalforSurgicalIntensiveCareUnitrotation: Tounderstandthebasicsofcareforthecriticallyillsurgicalpatient.

ResidentObjectives: ACGMECompetencyGoals

Understandthedifferenttypesofshock.

Understandthevarioustypesofmonitoringcathetersandhowtointerpretthedata obtained

Understand thebasicprinciplesofmechanicalventilation.

Understandeffectivepreventivemeasuresfordeepveinthrombosisandpulmonary embolus.

Understand thebasicsofEKGinterpretation

MedicalKnowledge

PatientCare

MedicalKnowledge

Understandthebasicsofrenalphysiologyandelectrolytedisturbances.

Understandthebasicsofpulmonaryphysiology

Beabletomanagethenutritionalneedsofthesurgicalpatient.

MedicalKnowledge

PatientCare

Learnaboutoptimalcommunicationbetweentheintensivistsandsurgicalteams. Professionalism

Systems-BasedPractice

GoalsofEmergencyMedicinerotation: Tounderstandthebasicsofcareintheemergencydepartment.

ResidentObjectives:

LearnabouttheprocessofE.D.triage.

KnowhowtoevaluatethemostcommondisordersseeninE.D.patients.

LearnhowtoworkwiththeE.D.personnelandothermedicalprofessionalstoevaluateand treatpatients.

Learnthebasicsoflacerationclosure.

GoalsforAnesthesiaRotation:Tobecomefamiliarwiththebasicsofanesthesiacare.

ResidentObjectives:

Knowbasiclaryngealanatomy.

Know appropriateindicationsforgeneralversuslocalversusregionalanesthesia.

Know theimportantfeaturesofthemostcommonsurgicalanestheticsusedinthe operatingroom.

Understand appropriatepreoperativetestsforpatientsundergoinganesthesia.

Beabletointerprettheanesthesiarecord.

Befamiliarwithvarioustypesofintraoperativemonitoring.

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

PatientCare

MedicalKnowledge

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Beabletoperformorotrachealintubation.

Learnaboutoptionalcommunicationbetweenanesthesiaandsurgicalteams.

Learnhowtoparticipateina“timeout”sessionandunderstandtheimportanceofsurgical checklists.

Goals

Neuroradiology/Audiology/Neurology/Laryngology/Research

PatientCare

Professionalism

Systems-BasedPractice

PatientCare

Systems-BasedPractice

rotation:Tobecomefacileatorderingandreadingimaging studiesoftheheadandneck,tounderstandthebasicsofaudiologyandvestibulartesting,becomefamiliarwithbasicneurological assessments,andlearnthefundamentalsofconductingmedicalresearch.

ResidentObjectives:

KnowtheanatomyoftheheadandneckasseenonCTandMRI.

Understandwhichtypeofimagingstudyisbestforwhichtypeofclinicaldisorder.

Understand theappearanceofcommonheadandneckdisordersasseenonradiologic images.

Learnhowtobestinteractwithmembersoftheradiologydepartment.

SpendatleasttwosessionsobservingaCT/MRItechnologisttodevelopfamiliaritywith scanningprocesses,radiationdosingandsafety.

AttendOHNSandneuroradiologyeducationconferences

Project:Assemble10to15casesofinterest.TheseshouldbeinPowerPointformatand presentedasteachablecases.IntheirPGY2year,theresidentwillpresentthisat aresidency educationsession.

Spendtimeinaudiologyaminimumof oneafternoon/weeklearningaboutaudiologic testingforallages,hearingaidsandcochlearimplants.

Learnthebasicsofaudiologyevaluationinadults.Beabletoperformanaudiogram.

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

PracticeBasedLearning

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Learnandobservethetypesofaudiologictestinginchildren.

Understand thetypesofnewbornhearingscreensandtheassociatedlawsregarding screening.

Observethevarioustypesofvestibulartestingandunderstandwheneachtypeis indicated.

Learntotakeadetailedvertigo/dizzinesshistory.

Becomefamiliarwithhowtoconductathoroughvestibularphysicalexam

Begintounderstand theworkupofavestibularpatient

Obtainexposuretohowtointerpretresultsofvestibular/balancetesting,includingVEMP, VHIT,VNG,rotarychair,CDP

Describevestibularpathologies,bothcentralandperipheral.

Learnmanagementoptionsinthetreatmentofpatientswithdizziness.

Attendorviewonlineresearchtrainingcourse

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

StanfordHealthCareHeadmirrorService

RotationDirectors: Laryngology SleepMedicine Comprehensive

C.KwangSung,MD,MS

kwangs@stanford.edu

WeeklySchedule

Monday

MegwaluOR Leeclinic

CapassoOR(RWC)

Nuyenclinic(RWC)

RobsonCapasso,MD

rcapasso@stanford.edu

SungORorprocedure clinic(801)

Capassoclinic(RWC) Megwaluclinic

Sungclinic(RWC)

CapassoOR Leeclinic

UchechukwuMegwalu,MD,MPH

umegwalu@stanford.edu

LeeOR(alternateweeks)

Damroseclinic(RWC)

Capassoclinic(RWC)

Megwaluclinic

LeeOR(alternateweeks)

DamroseOR

SungOR(4th &5thFri)

MegwaluOR Leeclinic

Nuyenclinic(RWC)

SungORorprocedure clinic(801)

Capassoclinic(RWC)

Megwaluclinic

Sungclinic(RWC)

CapassoOR Leeclinic

Liuclinic(RWC)

LeeOR(alternateweeks)

Damroseclinic(RWC)

Capassoclinic(RWC)

Megwaluclinic

GoalsandObjectivesPGY1:SHCHeadmirrorService

LeeOR(alternateweeks)

DamroseOR

SungOR(4th &5thFri)

ThePGY-1willparticipateinotolaryngologyroundsandunderthedirectionofthechief/seniorresidentwillberesponsibleforcare of inpatients.

Callduties:ThePGY1residentwilltakecallforin-housefloorpatientsfrom6:00amuntilafterroundsarecompleteandresidentsare releasedbythechiefresident.Onassignedweekends,theywilltakefloorcallduringtheday.PGY-1residentswillnottakeovernight call.

NOTE: Allresidents,includingthePGY1residents,willtakethein-trainingexamonthefirstSaturdayinMarch.

EvaluationandFeedback

TheOHNSFacultyontheHeadmirrorService(andselectedancillarymedicalpersonnel)willcompletewrittenevaluationsattheendof therotation.Selectedclinicpatientswillevaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberandthe rotation.Dailyfeedback onphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1:Otolaryngology(“Headmirror”)Rotation:Tobeabletoprovidepre-andpost-operativecarefortheotolaryngologysurgical patient.

ResidentObjectives:

•Knowtheimportantaspectsofhistoryandphysicalexaminationoftheotolaryngology patient.

•Begintounderstandthediagnosisand treatmentofcommonotolaryngologicdisorders.

•BecomefamiliarwiththeACGMEresidentcaselogsystem.

•Demonstrateself-awarenessandtimemanagement/organizationalskills.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Systems-BasedPractice

Practice-BasedLearningandImprovement

Goal2:Otolaryngology(“Headmirror”)Rotation:Tobegintodevelopotolaryngologysurgical andprocedural skills.

ResidentObjectives:

•Residentwillknowthenamesofcommonsurgicalinstruments.

•Residentwilllearnbasicsuturingandknottyingtechniques.

•ResidentwillknowhowtosetuptheORforroutineotolaryngologycases.

•ResidentwilllearnthebasictechniquesofDirectlaryngoscopy,Esophagoscopy, Bronchoscopy.

•ResidentwilllearnthebasictechniquesofDISE/flexiblenasopharyngoscopy,inferior turbinatereduction,frenulotomy,archbarremoval,tonsillectomy.

•Residentwillgainexperiencebyassistingwithsurgicalprocedures.

•Residentwillbeintroducedtoflexiblelaryngoscopy andvideostroboscopy.

•Residentwilllearnbasicsofdissectionofsofttissueofthefaceandneck.

GoalsandObjectivesPGY2/3:SHCHeadmirrorService

ACGMECompetencyGoals

PatientCare

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Capasso,Damrose,Lee, MartinsGomes deOliveira,Megwalu,Nuyen,Sung,Tham)

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow-up. The teamshouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobeteachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

• Communicationofsomesortisexpectedeachdaywith each attending.Forsome,atextmessageisfine;forothers,aphone call. Atthestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

• Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty.Theyshouldtellthepatient that theywillcheckwiththeattending.

3. Communicationwithfacultyregarding night-timecontactwithpatients Forseriousissues(e.g.shouldapatientgobacktothe OR),itisidealifcallsgoupthechainofcommand.R2sandR3soncall shouldcalltheirchiefresidenttoevaluate,whoshouldnotifythefellow,andthentheattending.TheR2orR3shouldNOT bypassseniorresidentsandgodirectlytotheattending. Thisisforteachingpurposes.

4. Residentsareexpectedtomakeentriesintomedicalrecordsfornight-timepatientcontacts.AnoteshouldbeenteredintoEpic foreachcontactwithpatients.

5. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshould anticipateandplaninadvancesothatclinicscanbecoveredasmuchaspossible.Thismayrequireaskingresidentsfromother servicestohelp.ItmaybeadvisabletolimitvacationduringthemonthsofheavyR4interviews.

6. Abriefoperativenoteshouldbeenteredwithinanhourofcompletionofthesurgerybytheresident.Dictationofoperative reports:within24hours.

7. PreparationforOR:Decideapersonalgoaltoachieveineachcase. Discusscasewithattendingthedaybefore.Readaboutthe case.Knowthepatientandwhytheoperationisbeingperformed,thelabs,etc. Seekfeedbackfromfacultybydirectlyasking faculty.

8. Whenfacultyisoutoftown,continuetocommunicatewithattendingdailyifavailablebycellphone.Ifnot,then,communicate withthecoveringattendingorinstructor(designatedbytheattendingpriortoleaving).

EvaluationandFeedback

TheOHNSFacultyontheHeadmirrorService(andselectedancillarymedicalpersonnel)willcompletewrittenevaluationsattheendof therotation.Selectedclinicpatientswillevaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberandthe rotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1. Consultsinanadulttertiarycarehospital. Learnaboutthemostcommonconsultsrequestedfromothermedicaland surgicalservicesregardinglaryngeal and generalotolaryngologyproblems inadults.

ResidentObjectives:

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandtheemergency department.

Performinitialevaluationofallconsultpatients whendesignatedandforalllaryngology consults.

BefamiliarwiththeSHCelectronicmedicalrecord(EPIC)andbeabletoaccess informationappropriately. Understandtheimportanceofconfidentialityinpatient medicalrecords.

Evaluateconsultpatientswith seniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon-clinicalstaffmembers.

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism

Systems-BasedPractice

PatientCare

MedicalKnowledge

PatientCare

Professionalism

Systems-BasedPractice

PatientCare

MedicalKnowledge

Systems-BasedPractice

InterpersonalandCommunicationSkills

MedicalKnowledge

Practice-BasedLearningand Improvement

InterpersonalandCommunicationSkills

Createacompleteandcoherent consultationnoteanddictateitinatimelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

Utilizetranslationservicesto communicatewithnon-Englishspeakingpatientsasneeded.

Demonstrateeffectivetime-managementskills.

Follow-uponconsultpatientsasneeded.

PrepareandpresentattheweeklyHeadandNeckCaseconference.

Goal2. Hoarseness.

ResidentObjectives:

Professionalism

InterpersonalandCommunicationSkills

Systems-BasedPractice

Practice-BasedLearningandImprovement

Professionalism

PatientCare

Systems-BasedPractice

Professionalism

MedicalKnowledge

Systems-BasedPractice

Screen,diagnoseandmanagepatientswithsymptomssecondarytovocalfold/laryngeal pathology.

ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyofthelarynx.

Takeahistorywithfocusedquestionsthatassistinthediagnosisofhoarseness.

Describetheuseofdiagnostictestsforassessinghoarseness(e.g.airwayfilms,sleep studies,laryngealendoscopy,videostroboscopy).

Beableonphysicalexaminationtoassess abnormalitiesofthevocalfolds(ie,paralysis).

Describehowtoidentifyaparalyzedvocal fold.

Beabletocounselpatients/parentsaboutthepathophysiologyofconditionsassociated withvocalfoldparalysis.

Understandtheindicationsformedialization(e.g.,injection,thyroplasty)andalternative therapies.

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

Beabletocounselparentsabouttherisksandbenefitsofvocalfoldmedialization. Professionalism

InterpersonalandCommunicationSkills

Knowtheperioperativemanagementandexpectedpostoperativecourseofpatientswho undergovocalfoldmedialization.

Beabletosafelyandefficientlyperformaflexiblenasolaryngoscopy and videostroboscopy.

PatientCare

Beabletodiscussthetreatmentofandprovidecaretopatientswithcomplicationsof laryngoscopy.

Goal3.Swallowing. Beabletoevaluateandtreatswallowingdisordersinadults.

ResidentObjectives:

Beabletodescribetheanatomy,physiology,andpathophysiologyofthepharynxand esophagus.

Beabletotakeahistoryrelatedtothepharynxandesophagusasregardsswallowing problems.

Understandtheavailabletreatmentsfordysphagia.

Beabletodiscusstheindications,risks,benefitsandalternativestodilationandto cricopharyngealmyotomy.

BefamiliarwiththeendoscopicandopenmethodsoftreatingZenker’sdiverticulum.

Understandtheavailable bedsideand radiographicmethodsofassessingswallowing.

Beabletodiscussandtreatcomplicationsfromesophagoscopy.

Goal4.Expandabilitytoperformsurgicalprocedures

ResidentObjectives:

Beabletocompetentlyandefficientlyperformmid-levelprocedureswithattending assistance

PatientCare

Interpersonaland CommunicationSkills

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

ACGMECompetencyGoals

PatientCare suchas:

• Microdirectlaryngoscopy

• FlexibleandrigidEsophagoscopy.

• Injectionlaryngoplasty

• Tonsillectomy

• Septoplasty

• Turbinatereduction

• Tracheostomy

• Panendoscopy

• Submandibularglandexcision

• Excisionofcongenitalcysts

• Eustachiantubedilation

• Resectionofsmallcarcinomas(e.g.tongue,floorofmouth)

Goal5.SleepMedicine. Knowaboutnormalsleep/wakeneurobiologyandrespiratoryphysiology

ResidentObjectives:

Befamiliarwiththesleep/wakeneuralcentersandconnectionsassociatedwithnormal sleep/wakecycles.

Knowthesleepstagesandarchitecture.

Understandoptionsfortreatmentofnasalseptaldeviationandturbinatehypertrophy..

Goal6.Knowaboutcommonsleepdisordersandtheirconsequences

ResidentObjectives:

Beabletodefineanddescribethefollowingsleepdisorders:

Sleeprelatedbreathingdisorders(SRBD)

Insomnia

Circadianrhythmsleepdisorders

Hypersomnias,parasomniasandsleeprelatedmovementdisorders

Insufficientsleepsyndrome.

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

Goal7.Knowhowtoobtainasleephistoryandcomprehensivephysicalexaminationinpatientswithsleepcomplaints

ResidentObjectives:

Beabletoobtainasleephistoryincludingtheabilitytoidentifyassociatedcomorbiditiesfrompoorsleep:moodandcognitivedysfunction,hypertension,atrial fibrillation,cerebrovascularaccidents.

KnowtheEpworthsleepinessscaleandbeabletoadministerandinterprettheresults.

ACGMECompetencyGoals

PatientCare

InterpersonalandCommunicationSkills

PatientCare

InterpersonalandCommunicationSkills

Beabletoidentifycraniofacialandsofttissue abnormalitiesassociatedwithSRBD. PatientCare

InterpersonalandCommunicationSkills

Goal8.Understandtheoptionsforevaluatingpatientswithsleepdisordersandhowtointerprettheappropriateclinicalstudies.

ResidentObjectives:

ACGMECompetencyGoals

Understandtechnologicaltoolsinvolvedinpolysomnographicandhomemonitoring devices,includingEEG,EMG,EOG,EKG,airflowsensors,respiratoryeffortbelts, oximetry/gasmonitoring,esophagealpressure,arterialpletismography.

Beableonapolysomnogramtoidentifyrespiratoryeventsincluding apneas/hypopneas, RERAsandhypoventilation.

Understandtheindicationsandinterpretationofthemultiplesleeplatencytest.

Understandtheuseofimagingstudiesinpatientswithsleepdisorders.

Goal9.Improvegeneralotolaryngologyknowledge

ResidentObjectives:

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceat radiologyrounds.

Learntoset-upandusethefacialnerveintegritymonitor.

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers.

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD-9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodsto appraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

MedicalKnowledge

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

PatientCare

Systems-BasedPractice

Professionalism

Systems-BasedPractice

Professionalism

Practice-BasedLearningandImprovement

• DuringPGY2/3orPGY4’svacation/conference/interviewperiod,Half-timeResearchResidentusuallyworksasfulltime.

GoalsandObjectivesPGY4:SHCHeadmirrorService

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeons (Capasso,Damrose,Lee,MartinsGomesdeOliveira, Megwalu,Nuyen,Sung, Tham)

Note:ifthereisnoO.R.goingon(e.g.,attendingphysicianisoutoftown),theresidentisexpectedtoattendclinic.

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow-up. Theteam shouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobe teachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

• Communicationofsomesortisexpectedeachdaywith each attending. Forsome,atextmessageisfine;forothers,aphonecall. Atthestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

• Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatient thatthey willcheckwiththeattending.

3. Communicationwithfacultyregarding night-timecontactwithpatients

Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcalltheir chiefresidenttoevaluate,whoshouldnotifythefellow,andthentheattending.TheR2shouldNOTbypasssenior residentsandgo directlytotheattending. Thisisforteachingpurposes.

4. Residentsareexpectedtomakeentriesintomedicalrecordsfornight-timepatientcontacts.AnoteshouldbeenteredintoEpicfor eachcontactwithpatients.

5. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshouldanticipate andplaninadvancesothat casescanbecoveredasmuchaspossible. Thismayrequireaskingresidentsfromotherservicestohelp. ItmaybeadvisabletolimitvacationduringthemonthsofheavyR4interviews.

6. Abriefoperativenoteshouldbeenteredwithinanhourofcompletionofthesurgerybytheresident.Dictationofoperative reports: within24hours.

7. PreparationforOR:Decideapersonalgoaltoachieveineachcase. Discusscasewithattendingthedaybefore.Readaboutthecase. Knowthepatientandwhytheoperationisbeingperformed,thelabs,etc. Seekfeedbackfromfacultybydirectlyaskingfaculty.

8. Whenfacultyisoutoftown,continuetocommunicatewithattendingdailyifavailablebycellphone. Ifnot,then,communicatewith thecoveringattendingorinstructor(designatedbytheattendingpriortoleaving).

Evaluationand Feedback

TheOHNSFacultyontheHeadmirrorService(andselectedancillarymedicalpersonnel)willcompletewrittenevaluationsattheendofthe rotation. Selectedclinicpatientswillevaluatetheresidents. ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1.Expandknowledgeintheareaof laryngealoncology

ResidentObjectives:

Beabletoidentifyclinicallysuspiciouslesionsofthe larynxandesophagus,perform appropriatebiopsiesandimagingstudiestomakeadiagnosisinacosteffectiveand timeefficientmanner.

Understandriskfactorsforheadandneckcancer,beabletoassesspatientsforrisk factorsandbeabletocounselpatientsaboutmanagingtheriskfactors.

Beabletoacquireappropriateinformationtostage laryngealcancers,topresentcases intheHeadandNeckTumorBoardandtodeterminethebesttreatmentmodalityor modalities. WhenpresentingthecasesinTumorBoard,up-to-dateliteraturewillbe usedtosupporttreatmentdecisions.

Beabletodiscussthetreatmentoptionswiththepatientandmaketheappropriate consultations(medicaloncology,radiationoncology,dentistry,speechpathology, physicaltherapy,nutrition,andorsocial work)basedonthepatient’sneedsand wishes.Thiswillrequireconsiderationofthepatient’srightsandasensitivityto cultural,age,genderanddisabilityissues.

Administercareforthepost-operativeoncologypatient.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

Systems-BasedPractice

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare

Professionalism

Systems-BasedPractice

Professionalism

Practice-BasedLearningandImprovement

Interpersonaland CommunicationSkills

PatientCare

MedicalKnowledge

Beabletodescribeprinciplesaboutandperforminterventionsforearlylaryngeal cancer.

Beabletoperforminterventionsfor advanced laryngealcancer.

Goal2: Becompetentinevaluatingandmanagingotolaryngologypatients.

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Expandandrefineevaluationand managementskillsofotolaryngologypatients. SuchknowledgeshouldallowtheR4residenttoconfidentlyandindependentlycare forotolaryngologypatientsbytheendoftheyear.

Expandparticipationtoincludea leadershiproleinteachingconferencesfacilitating thelearningofthejuniorresidentsandmedicalstudents.

ExpandknowledgeofOtolaryngologyliteraturefor diseasesanddisordersofthe larynxandsleepsurgery.

Understandthelimitsofsurgicalandmedicaltreatment.

Understandindicationsforurgentoperativedecisions,suchasaperformingasurgical airwayanddecompressinganexpandingneckhematoma

Recognizeandmanagesurgicalrisk-factors.

Administercareforthepost-operativepatient.

Expandthecapacitytorecognizeandtreatpost-surgicalcomplicationseffectively, andlearntorecognizepreoperativeriskfactors.

Gainahealthyappreciationforthedangersinherentinmedicalintervention,and learnhowtobeappropriateinselectingpatientsforsurgery.

MedicalKnowledge

PatientCare

Practice-BasedLearningandImprovement

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

Practice-BasedLearningandImprovement

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Practice-BasedLearningandImprovement

PatientCare

Assumealeadershiproleinpostoperativecareofcomplicationssuchassalivary fistula,woundinfection,hematoma,cerebrospinalfluidleak,airwaycompromise, andhemorrhage.Teachthejuniorresidentsandmedicalstudentstomanagethese complications.

Beabletosuccessfullytransitionfromsupervisionbyfacultytoprimarydecision makingwithfacultyoversight.

Supervisepresentationofcomplicationsontheserviceatmonthly Morbidityand Mortalityconference.

Demonstratecompetenceandorganizationalskills indirectingtheresidentteamin thedailymanagementofin-housepatientsandORactivities.

Demonstrateabilityandcommitmentintheday-to-dayinformalteachingand mentoringofstudentsandjuniorresidents.

Beabletocompetentlysupervise/assistjunior residentsperformingcommon OTO/HNSsurgicalprocedures.

Beabletodemonstrateexcellentinterpersonalskills,effectivelysettingthetonefor othermembersoftheresidentteam,clinicalandnon-clinicalstaff.

Practice-BasedLearningandImprovement

PatientCare

Practice-BasedLearningandImprovement

Professionalism

Goal3.Airway.Beabletoevaluateandformtreatmentplansforadultswithairwayobstructiondueupperairwayandtracheal lesions.

ResidentObjectives:

ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,and pathophysiologyofthelarynx. MedicalKnowledge

Beabletorecognize,describeandcategorizestridorinadults. Knowthemost commoncausesofstridoranddyspneainadults.

Beabletodescribethevarious methodsformanagingacomplexairwaypatient(i.e. awakefiberopticintubation,hi-flownasalcannula, jetventilation,laryngealmask airway,rigidbronchoscopy,awaketracheostomy);theirindicationsandtheirpossible complications.

Beabletodiscussroutinecareofatracheostomyanddescribehowtorecognize tracheostomyobstructionordecannulation.Beabletoeducateapatientaboutthe

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

risks/benefitsandcareofatracheostomy.Beknowledgeableabouthowtoobtainthe neededtracheostomyrelatedequipmentforpatientuseathome.

Befamiliarwiththeprincipallesionsthatcanaffectvocalfoldfunctioninadults(i.e. papilloma,polyp,nodule,cancer).

Beabletoidentifythevariousmethodsforlaryngealframeworksurgery(e.g. thyroplasty,arytenoidsadduction);theirindicationsandtheirpossiblecomplications.

Knowtheinstrumentationusedtoresectlaryngeallesions(i.e.endoscopicscissors, graspers,laser).

InterpersonalandCommunicationSkills

Systems-BasedPractice

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Goal4.Videostroboscopy. Beabletoutilizeandtointerpretvideostroboscopyinthediagnosisoflaryngealdisorders.

ResidentObjectives: ACGMECompetencyGoals

Befamiliarwiththesetupandtechniqueofvideostroboscopy.

Understandthevariouscomponentsoflaryngealfunctionwhichcanbeassessedwith videostroboscopy(ie,vocalfoldwaveform,amplitude,glotticgap,etc).

Recognizethecharacteristicfeaturesofvariousdisordersasdiagnosedby videostroboscopy(ie,nodules,polyps,cysts,granulomas,spasmodicdysphonia).

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Goal5. SleepMedicine.Beabletoeffectivelyevaluateand treatapatientwithasleeprelatedbreathingdisorder.

ResidentObjectives: ACGMECompetencyGoals

KnowtheindicationsforPAPtherapy,anddifferentmodalitiesincludingCPAP,auto PAP,BiPAP,AutoBIPAP,AVAPS,andASV.

EvaluateandstimulatePAPcompliancethroughclinicalhistoryanddatadownloaded fromPAPmachine.

UnderstandandbeabletorecommendmethodstoimprovePAPcomplianceincluding maskrefitting,useofEPR,referraltobehavioraldesensitization.

PatientCare

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare

InterpersonalandCommunicationSkills

Systems-BasedPractice

PatientCare

Beabletointegratewithothermembersofasleepcenter,andknowhowto adequatelyreferpatientsformedical,dental,andbehavioralmanagementofsleep disorders.

Beabletoanalyzedatafromthehistory,physicalexamination,sleeptest,nasal endoscopy,druginducedsleependoscopy,andimagingtestsand identifywhowill benefitfromsomesortoftherapyandwhichtherapyshouldberecommended.

Beabletoselectappropriatecandidatesfororaldevicetherapy.

Beabletoinformthepatientaboutweightloss,behavioralandpositional managementofSRBD.

Beabletoethicallyandthoroughlyprovideallavailabledatatopatientsandhelp him/hermake thebestpossibledecisiononsurgicalcareofOSA.

Understandtheindications,roleandrealisticgoalsofsurgery. Beabletoperforman adequatepsychosocialassessmentand explainwhynosurgicalinterventionmaybe thebestchoiceforsomepatients.Beabletoformulateanindependentplanfor surgicalmanagementofobstructivesleepapnea.Performingseptoplasty,turbinate reduction,uvulopalatopharyngoplasty.

Understandtheindications,techniques,benefitsandrisksofsleepsurgeryinvolving thefacialskeleton(maxillomandibularadvancement,maxillary expansion/DOME, genioglossusadvancement). Performingcriticalpartsoftheprocedure.Incorporate virtualsurgicalplanning.

Understandtheinclusioncriteriaofhypoglossalnervestimulation.Performingcritical Partsoftheprocedure. Understandtheactivationprotocolafterimplantation.

UnderstandanddescriberisksandcomplicationsofOSAsurgery,includingvoiceand swallowingchanges,complexpainmanagement,facialparesthesias,infection,need forHGNSexplant,facialprofileandcosmeticchangesandneedforrevisionsurgery.Be abletoeffectivelyandcompassionatelycounselpatientsofthesedetails.

Effectivelyandcomprehensivelymanageprimaryinhouse,post-operativeandconsult patientswithobstructivesleepapneawiththejuniorandseniorresidents.

Systems-BasedPractice

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare

InterpersonalandCommunicationSkills

Professionalism

PatientCare

InterpersonalandCommunicationSkills

Professionalism

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism

PatientCare

MedicalKnowledge

Demonstrateappropriatesurgicaltechniqueforuvulopalatopharyngoplasty,beable toperformmostofthecervicalapproachinhypoglossalnervestimulationcases.Be abletoperformLefortosteotomiesduringmaxillomandibularadvancement

Systems-BasedPractice

PatientCare

MedicalKnowledge

Goal6.Improvecompetencyintheperformance of laryngology,sleep,andgeneralotolaryngology surgeries

ResidentObjectives: ACGMECompetencyGoals

Beadeptinperformingthefollowingprocedures:

· Diagnosticendoscopy

· Operativemicrolaryngoscopy

· Tracheotomy

· Submandibularglandexcision

. Sublingualglandexcision

· EndoscopicdilatationandCO2laserresectionforsubglotticstenosisand posteriorglotticstenosis

· Uvulopalatopharyngoplastyanditsmultiplemodifications

· Tonguesurgery-volumereductionand/ortonguesuspension/suture

Becomeincreasinglyskilledinperformingthefollowingprocedures:

· NeckDissection

· Laryngectomy(totalandpartial)

· Laryngopharyngectomy

· Parotidectomy

· Thyroidectomy

· Parathyroidectomy

· TypeIthyroplasty

· Arytenoidadduction

· Cricotrachealresection

· Trachealresection

· Maxillomandibularadvancement,maxillaryexpansion/DOME,genioglossus advancement

· Hypoglossalnervestimulator implant

PatientCare

Knowtheindications,perioperativecare,expectedoutcomesandpossible complicationsforallprocedureslistedabove.

PatientCare

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare

Goal7. Beabletotakecareofpatientsinanethical,efficientandcaringmannerwithinthe currentmedicalsystem

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,and outpatientvisits(CPTandICD-9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandto complywithinsurancepayor regulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicand ethnicfactorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sownabilitiesandlimitationsincludingawareness ofsignsoffatigue.

PrepareandguidejuniorresidentspresentationatweeklyHeadandNeckCase conference.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstrate theabilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraise clinicalstudies. Performliteraturesearchesasneededtocontinuouslyimprovethe levelofmedicalknowledge.

PatientCare

Systems-BasedPractice

Professionalism

PatientCare

InterpersonalandCommunicationSkills

Systems-BasedPractice

Professionalism

InterpersonalandCommunicationSkills

Professionalism

Practice-BasedLearningandImprovement

MedicalKnowledge

Systems-BasedPractice

MedicalKnowledge

Practice-BasedLearningandImprovement

RotationDirector: FredBaik,MD fbaik@stanford.edu

StanfordHealthCareScalpelService

GoalsandObjectivesPGY1:SHCScalpelService

ThePGY-1willparticipateinotolaryngologyroundsandunderthedirectionofthechief/seniorresidentwillberesponsibleforcare of inpatients.

NOTE: Allresidents,includingthePGY1residents,willtakethein-trainingexamonthefirstSaturdayinMarch.

EvaluationandFeedback

TheOHNSFacultyontheScalpelService(andselectedancillarymedicalpersonnel)willcompletewrittenevaluationsattheendofthe rotation.Selectedclinicpatientswill evaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1:Otolaryngology(“Scalpel”)Rotation:Tobeabletoprovidepre-andpost-operativecarefortheotolaryngologysurgical patient.

ResidentObjectives:

•Knowtheimportantaspectsofhistoryandphysical examinationoftheotolaryngology patient.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

•Begintounderstandthediagnosisandtreatmentofcommonotolaryngologicdisorders. PatientCare

MedicalKnowledge

•Demonstrateproficiencyinmedicaldocumentation(progressnotes,dischargesummaries) withcomprehensivephysicalexaminations,assessmentsanddifferentialdiagnoses

PatientCare

MedicalKnowledge

Systems-basedpractice

•BecomefamiliarwiththeACGMEresidentcaselogsystem.

•Demonstrateself-awarenessandtimemanagement/organizationalskills.

•PrepareandpresentattheweeklyHeadandNeckCase Rounds

Goal2:Otolaryngology(“Scalpel”)Rotation: Tobegintodevelopotolaryngologysurgicalskills.

ResidentObjectives:

•Residentwillknowthenamesofcommonsurgicalinstruments.

•Residentwilllearnbasicsuturingandknottyingtechniques.

•ResidentwillknowhowtosetuptheORforroutineotolaryngologycases.

•ResidentwilllearnthebasictechniquesofDirectlaryngoscopy,Esophagoscopy, Bronchoscopy.

•Residentwillgainexperiencebyassistingwithsurgicalprocedures.

•Residentwillbeintroducedtoflexiblelaryngoscopy.

PatientCare

MedicalKnowledge

Systems-BasedPractice

Practice-BasedLearningandImprovement

MedicalKnowledge

Systems-BasedPractice

ACGMECompetencyGoals

PatientCare

Goal3:Otolaryngology(“Scalpel”)Rotation: Tobegintoorganizeaplanforaresearchprojectduringresidency.

ResidentObjectives:

•Meetwithatleasttwofacultymembersaboutpossibleresearchprojectsduringthe otolaryngologyresearchrotationinthePGY3year.

ACGMECompetencyGoals

Professionalism

GoalsandObjectivesPGY2/3:SHCScalpelService

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Baik, Chen,Divi,Finegersh,Holsinger,Lee, Orloff,Sirjani,Sunwoo,Yao)

RotationSpecifics

teamshouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobeteachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

3. Communicationofsomesortisexpectedeachdaywith each attending. Forsome,atextmessageisfine;forothers,aphonecall. Atthestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

4. Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatient that theywillcheckwiththeattending.

5. Communicationwithfacultyregarding night-timecontactwithpatients Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcall theirchiefresidenttoevaluate,whoshouldnotifythefellow,andthentheattending.TheR2shouldNOTbypasssenior residents andgodirectlytotheattending. Thisisforteachingpurposes.

6. Residentsareexpectedtomakeentriesintomedicalrecordsfornight-timepatientcontacts.AnoteshouldbeenteredintoEpic foreachcontactwithpatients.

7. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshould anticipateandplaninadvancesothatclinicscanbecoveredasmuchaspossible. Thismayrequireaskingresidentsfromother servicestohelp.ThereshouldneverbeachiefandtheR4goneatthesametime. Itmaybeadvisabletolimitvacationduringthe monthsofheavyR4interviews.

8. Abriefoperativenoteshouldbeenteredwithinanhourofcompletionofthesurgerybytheresident.Dictationofoperative reports:within24hours.

9. PreparationforOR:Discusscasewithattendingthedaybefore eitherverballyorbyemail. Readaboutthecase. Knowthe patientandwhytheoperationisbeingperformed,thelabs,etc.

10. Whenfacultyisoutoftown,continuetocommunicatewithattendingdailyifavailablebycellphone. Ifnot,then,communicate withthecoveringattendingorinstructor(designatedbytheattendingpriortoleaving).

11. Theresidentisrequiredtoattend weeklyattendingroundsonFridays. Atthisconference,thePGY-2willpresentacaseassigned bythechiefresidentandknowthetumorstageandbasicmanagementstrategies.

12. TheresidentwillalsoattendH&Ntumorboardinadditiontotheregularlyscheduledresidenteducationconferences.

EvaluationandFeedback

TheOHNSFacultyontheScalpelService(andselectedancillarymedicalpersonnel)willcompletewrittenevaluationsattheendofthe rotation. Selectedclinicpatientswillevaluatetheresidents. ResidentswillbeaskedtoevaluateeachFacultyMemberandthe rotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1. Expandknowledgeinareaofheadandneckoncology.

ResidentObjectives:

Beabletoaccuratelystagecancersoftheheadandneck.

Developanunderstandingoftheroleofchemotherapyandradiationtherapyinthe treatmentofheadandneckcancer.

Begintobeabletoformulateatreatmentplanforheadandnecktumorswithsupervision, andbeabletoeffectivelycounselpatientsregardingtreatmentoptionsincludingrisks associatedwithsurgicaltreatment.

Adequatelyassessflapviabilityandrecognizevenouscongestionorarterialinsufficiency

Progressinabilitytocounselpatients regardingheadandneckcancerriskfactors.

Developanunderstandingoftheroleofsurgeryinthetreatmentofsquamouscell carcinomaoftheheadandneck.

Begintounderstandtheappropriatesurgicalproceduresforthetreatmentofheadandneck cancers.

Beabletowork-upandtreatpatientswiththyroidandparathyroiddiseases.

Beabletowork-upandtreatpatientswithmelanomaoftheheadandneck.

Beabletowork-upandtreatpatientswithsalivaryglandtumors.

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Practice-BasedLearningandImprovement

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Practice-BasedLearningandImprovement

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Beabletorecognizethehistopathologicappearanceofcommonheadandneckneoplasms, includingparotidandthyroidpathology.

MedicalKnowledge

Goal2. Consultsinanadulttertiarycarehospital. Learnaboutthemost commonconsultsrequestedfromothermedicaland surgicalservicesregardingotolaryngologyproblemsinadults.

ResidentObjectives:

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandtheemergency department.

Performinitialevaluationofallconsultpatients.

BefamiliarwiththeSCHelectronicmedicalrecord(EPIC)andbeabletoaccessinformation appropriately. Understandtheimportanceofconfidentialityinpatientmedicalrecords.

Evaluateconsultpatientswithseniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon-clinicalstaffmembers.

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems.

Createacompleteandcoherentconsultationnoteanddictateitina timelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

Utilizetranslationservicestocommunicatewithnon-Englishspeakingpatientsasneeded.

Demonstrateeffectivetime-managementskills.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism

Systems-BasedPractice

PatientCare

MedicalKnowledge

PatientCare

Professionalism

Systems-BasedPractice

PatientCare

MedicalKnowledge

Systems-BasedPractice

InterpersonalandCommunicationSkills

MedicalKnowledge

Practice-BasedLearningandImprovement

InterpersonalandCommunicationSkills

Professionalism

InterpersonalandCommunicationSkills

Systems-BasedPractice

Practice-BasedLearningandImprovement

Professionalism

Follow-uponconsultpatientsasneeded.

PrepareandpresentattheweeklyHeadandNeckCaseconference orAttendingrounds.

Goal3.Expandabilitytoperformheadandnecksurgicalprocedures

ResidentObjectives:

PatientCare

Systems-BasedPractice

Professionalism

MedicalKnowledge

Systems-BasedPractice

ACGMECompetencyGoals

Beabletocompetentlyandefficientlyperformmid-levelprocedureswithattending assistance PatientCare suchas:

• Directlaryngoscopyandbiopsy

• Flexibleandrigidesophagoscopy.

• Tonsillectomy

• Tracheostomy

• Panendoscopy

• Submandibularglandexcision

• Excisionofcongenitalcysts

• Resectionofsmallcarcinomas(e.g.tongue,floorofmouth)

• Resectionofmelanomaoftheheadandneck

• Sentinellymphnodebiopsy

• Skingraftandflapreconstructionofheadandneckdefects

• Assistwithneckdissectionsandbegintounderstandtheanatomyandprinciples governingneckdissections

Goal4.Improvegeneralotolaryngologyknowledge

ResidentObjectives:

Developcompetenceintheinterpretationofheadandneckimagingstudiesthroughregular reviewofallpatientimagingand attendanceatradiologyrounds.

Learntoset-upandusethefacialnerveintegritymonitor.

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers.

CompetencyGoals

PatientCare

MedicalKnowledge

PatientCare

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD-9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomplywith insurancepayorregulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

Systems-BasedPractice

PatientCare

Systems-BasedPractice

Professionalism

Systems-BasedPractice

Professionalism

Practice-BasedLearningandImprovement

• DuringPGY2/3orPGY4’svacation/conference/interviewperiod,Half-timeResearchResidentusuallyworksasfulltime.

Goalsand ObjectivesPGY4:SHCScalpelService

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Baik, Chen,Divi,Finegersh,Holsinger,Lee, Orloff,Sirjani,Sunwoo,Yao)

Note:ifthereisnoO.R.goingon(e.g.,attendingphysicianisoutoftown),theresidentisexpectedtoattendclinic.

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow-up. Theteam shouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobe teachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

3. Communicationofsomesortisexpectedeachdaywith each attending. Forsome,atextmessageisfine;forothers,aphonecall. At thestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

4. Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatient thatthey willcheckwiththeattending.

5. Communicationwithfacultyregarding night-timecontactwithpatients Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcalltheir chiefresidenttoevaluate,whoshouldnotifythefellow,andthentheattending.TheR2shouldNOTbypasssenior residentsandgo directlytotheattending. Thisisforteachingpurposes.

6. Residentsareexpectedtomakeentriesintomedicalrecordsfornight-timepatientcontacts.AnoteshouldbeenteredintoEpicfor eachcontactwithpatients.

7. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshouldanticipate andplaninadvancesothatclinicscanbecoveredasmuchaspossible. Thismayrequireaskingresidentsfromotherservicestohelp. ThereshouldneverbeachiefandtheR4goneatthesametime. ItmaybeadvisabletolimitvacationduringthemonthsofheavyR4 interviews.

8. Abriefoperativenoteshouldbeenteredwithinanhourofcompletionofthesurgerybytheresident.Dictationofoperative reports: within24hours.

9. PreparationforOR:Discusscasewithattendingthedaybefore. Readaboutthecase. Knowthepatientandwhytheoperationis beingperformed,thelabs,etc.

10. Whenfacultyisoutoftown,continuetocommunicatewithattendingdailyifavailablebycellphone. Ifnot,then,communicatewith thecoveringattendingorinstructor(designatedbytheattendingpriortoleaving).

11. ResidentarerequiredtoattendtheThursdayH&Nteachingconference(H&Nteam)andtumorboardinadditiontotheregularly scheduledresidenteducationconferences.

EvaluationandFeedback

TheOHNSFacultyontheScalpelService(andselectedancillarymedical personnel)willcompletewrittenevaluationsattheendofthe rotation. Selectedclinicpatientswillevaluatetheresidents. ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1.Expandknowledgeintheareaof head&necksurgery,aswellasgeneralconceptsinsurgicaloncology

ResidentObjectives:

Beabletoidentifyclinicallysuspiciouslesionsoftheheadandneck,performappropriate biopsiesandimagingstudiestomakea diagnosisinacosteffectiveandtimeefficient manner.

Understandriskfactorsforheadandneckcancer,beabletoassesspatientsforriskfactors andbeabletocounselpatientsabout managingtheriskfactors.

Beabletoacquireappropriateinformationtostageheadandneckcancers,topresent casesintheHeadandNeckTumorBoardandtodeterminethebest treatmentmodalityor modalities. WhenpresentingthecasesinTumorBoard,up-to-dateliteraturewillbeused tosupporttreatmentdecisions.

Recognizeflapcomplications(flapfailure, salivaryfistula,hematoma)andinitiate appropriateintervention

Beabletodiscussthetreatmentoptionswiththepatientandmaketheappropriate consultations(medicaloncology,radiationoncology,dentistry,speechpathology,physical

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

Systems-BasedPractice

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare

Professionalism

Systems-BasedPractice

Patientcare

MedicalKnowledge

Systems-basedpractice

Professionalism

Practice-BasedLearningandImprovement

therapy,nutrition,andorsocialwork)basedonthepatient’sneedsandwishes.Thiswill requireconsiderationofthepatient’srightsandasensitivitytocultural,age,genderand disabilityissues.

Becomemorefamiliarwithablativeandreconstructiveoptions.

Understandtheroleofadjuvanttherapy.

Beabletowork-upandtreatpatientswiththyroidandparathyroiddiseases. Become familiarwiththeendocrinologyofthesedisordersandhowtodecidewhen interventionisappropriate.

Learnthefundamentalsofneckultrasound,toincludeoptimizationofmachinesettings andaccurateidentificationofpathology.

Beabletowork-upandtreatpatientswithmelanomaoftheheadandneck.

Beabletowork-upandtreatpatientswithsalivaryglandtumors.

PrepareandpresentattheweeklyHeadandNeckCaseconference orAttendingrounds.

Administercareforthepost-operativeoncologypatient.

Goal2.Improvecompetencyintheperformance ofheadandnecksurgeries

ResidentObjectives:

Beadeptinperformingthefollowingprocedures:

· Diagnosticendoscopy

· Operativemicrolaryngoscopy

· Tracheotomy

· Oralcavitycancerresections

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Systems-BasedPractice

Practice-BasedLearningandImprovement

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Systems-BasedPractice

PatientCare

MedicalKnowledge

ACGMECompetencyGoals

PatientCare

· Removalofskincancers

· Sentinellymphnodebiopsy

Becomeincreasinglyskilledinperformingthefollowingprocedures: PatientCare

· NeckDissection

· Laryngectomy(totalandpartial)

· Laryngopharyngectomy

· Compositeresection

· Regionalflapsforreconstruction

· Maxillectomy

· Parotidectomy

· Thyroidectomy

· Parathyroidectomy

Knowtheindications,perioperativecare,expectedoutcomesandpossiblecomplications forallprocedureslistedabove.

PatientCare

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare

Goal4. Beabletotakecareof patientsinanethical,efficientandcaringmannerwithinthecurrentmedicalsystem

ResidentObjectives:

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD-9).

Beabletoappropriatelydocument patientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

ACGMECompetencyGoals

PatientCare

Systems-BasedPractice

Professionalism

PatientCare

InterpersonalandCommunicationSkills

Systems-BasedPractice

Professionalism

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Professionalism

InterpersonalandCommunicationSkills

Developanunderstandingofone’sownabilitiesandlimitationsincluding awarenessof signsoffatigue.

PrepareandguidejuniorresidentspresentationatweeklyHeadandNeckCaseconference orAttendingrounds.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

Professionalism

Practice-BasedLearningandImprovement

MedicalKnowledge

Systems-BasedPractice

MedicalKnowledge

Practice-BasedLearningandImprovement

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Baik, Chen,Divi,Finegersh,Holsinger,Lee, Orloff,Sirjani,Sunwoo,Yao)

Note: ifthereisnoO.R.goingon(e.g.,attendingphysicianisoutoftown)residentisexpectedtoattendclinic.