Goals and Objectives PGY 4: SHC Scalpel Service

Goals and Objectives PGY 4: SHC Scalpel Service

Rotation Contacts and Scheduling Details

Please coordinate schedules and care with Attending Surgeons from Head and Neck Surgery (Baik, Divi, Holsinger, Kaplan, Noel, Orloff, Rosenthal, Sirjani, Sunwoo)

Note: if there is no O.R. going on (e.g. attending physician is out of town), the resident is expected to attend clinic.

Rotation Specifics

10. Rounding expectations: team is to round together in the morning with the chief resident leading. All members of the team are expected to know what is going on with each patient. On discharge, patients should have a date and time for follow-up. The team should establish this prior to discharge by calling the clinic or communicating with the P.A. The chief resident is expected to be teaching the juniors on rounds. 11. Communication with faculty regarding patients after rounds/weekends: • Communication of some sort is expected each day with each attending. For some, a text message is fine; for others, a phone call. At the start of the service, the chief should establish the best mode of communication with each attending. • When talking with patients, residents should avoid relaying care plans if there is uncertainty. They should tell the patient that they will check with the attending. 12. Communication with faculty regarding night-time contact with patients 13. For serious issues (e.g. should a patient go back to the OR), it is ideal if calls go up the chain of command. R2s on call should call their chief resident to evaluate, who should notify the fellow, and then the attending. The R2 should NOT bypass senior residents and go directly to the attending. This is for teaching purposes. 14. Residents are expected to make entries into medical records for night-time patient contacts. A note should be entered into Epic for each contact with patients. 15. Residents should strike a balance between learning in the clinic and operating room. However, the chief resident should anticipate and plan in advance so that clinics can be covered as much as possible. This may require asking residents from other services to help. There should never be a chief and the R4 gone at the same time. It may be advisable to limit vacation during the months of heavy R4 interviews. 16. A brief operative note should be entered within an hour of completion of the surgery by the resident. Dictation of operative reports: within 24 hours. 17. Preparation for OR: Discuss case with attending the day before. Read about the case. Know the patient and why the operation is being performed, the labs, etc. 18. When faculty is out of town, continue to communicate with attending daily if available by cell phone. If not, then, communicate with the covering attending or instructor (designated by the attending prior to leaving).

19. Resident are required to attend the Thursday H&N teaching conference (H&N team) and tumor board in addition to the regularly scheduled resident education conferences.

Evaluation and Feedback

The OHNS Faculty on the Scalpel Service (and selected ancillary medical personnel) will complete written evaluations at the end of the rotation. Selected clinic patients will evaluate the residents. Residents will be asked to evaluate each Faculty Member and the rotation. Daily feedback on physical findings, assessment, plan, and surgical technique will occur through clinical interactions.

Competency-based Goals and Objectives Goal 1. Expand knowledge in the area of head & neck surgery, as well as general concepts in surgical oncology

Resident Objectives: ACGME Competency Goals Be able to identify clinically suspicious lesions of the head and neck, perform appropriate biopsies and imaging studies to make a diagnosis in a cost effective and time efficient manner.

Understand risk factors for head and neck cancer, be able to assess patients for risk factors and be able to counsel patients about managing the risk factors. Patient Care Medical Knowledge Systems-Based Practice Patient Care Medical Knowledge Interpersonal and Communication Skills

Be able to acquire appropriate information to stage head and neck cancers, to present cases in the Head and Neck Tumor Board and to determine the best treatment modality or modalities. When presenting the cases in Tumor Board, up-to-date literature will be used to support treatment decisions. Be able to discuss the treatment options with the patient and make the appropriate consultations (medical oncology, radiation oncology, dentistry, speech pathology, physical therapy, nutrition, and or social work) based on the patient’s needs and wishes. This will require consideration of the patient’s rights and a sensitivity to cultural, age, gender and disability issues. Become more familiar with ablative and reconstructive options.

Understand the role of adjuvant therapy. Patient Care Professionalism Systems-Based Practice

Professionalism Practice-Based Learning and Improvement Interpersonal and Communication Skills

Patient Care Medical Knowledge Patient Care Medical Knowledge Systems-Based Practice Practice-Based Learning and Improvement

Be able to work-up and treat patients with thyroid and parathyroid diseases. Become familiar with the endocrinology of these disorders and how to decide when intervention is appropriate. Learn the fundamentals of neck ultrasound, to include optimization of machine settings and accurate identification of pathology. Be able to work-up and treat patients with melanoma of the head and neck.

Be able to work-up and treat patients with salivary gland tumors.

Prepare and present at the weekly Head and Neck Case conference.

Administer care for the post-operative oncology patient.

Goal 2. Improve competency in the performance of head and neck surgeries

Resident Objectives: Be adept in performing the following procedures: · Diagnostic endoscopy · Operative microlaryngoscopy · Tracheotomy · Oral cavity cancer resections · Removal of skin cancers · Sentinel lymph node biopsy Become increasingly skilled in performing the following procedures: · Neck Dissection · Laryngectomy (total and partial) · Laryngopharyngectomy · Composite resection · Regional flaps for reconstruction · Maxillectomy · Parotidectomy Patient Care Medical Knowledge

Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Medical Knowledge Systems-Based Practice Patient Care Medical Knowledge

ACGME Competency Goals Patient Care

Patient Care

· Thyroidectomy · Parathyroidectomy Know the indications, perioperative care, expected outcomes and possible complications for all procedures listed above. Patient Care

Demonstrate competence in the safe and appropriate use of various lasers. Patient Care

Goal 4. Be able to take care of patients in an ethical, efficient and caring manner within the current medical system

Resident Objectives: Develop competence in the interpretation of head and neck imaging studies through regular review of all patient imaging and attendance at radiology rounds. Learn the nuances of correctly coding surgical procedures, consultations, and outpatient visits (CPT and ICD-9).

Be able to appropriately document patient care to support coding levels and to comply with insurance payor regulations (e.g. Medicare).

Develop an understanding of and sensitivity to the impact of cultural, economic and ethnic factors in the doctor-patient relationship and the delivery of healthcare. Develop an understanding of one’s own abilities and limitations including awareness of signs of fatigue. ACGME Competency Goals Patient Care

Systems-Based Practice

Professionalism Patient Care Interpersonal and Communication Skills Systems-Based Practice Professionalism Professionalism Interpersonal and Communication Skills Professionalism Practice-Based Learning and Improvement

Prepare and guide junior residents presentation at weekly Head and Neck Case conference. Medical Knowledge Systems-Based Practice

Become an intelligent user of the academic literature in otolaryngology. Demonstrate the ability to apply knowledge of study designs and statistical methods to appraise clinical studies. Perform literature searches as needed to continuously improve the level of medical knowledge. Medical Knowledge Practice-Based Learning and Improvement