Goals and Objectives PGY 4: SHC Headmirror Service

Goals and Objectives PGY 4: SHC Headmirror Service

Rotation Contacts and Scheduling Details

Please coordinate schedules and care with Attending Surgeons (Capasso, Damrose, Dewan, Lee, Liu, Megwalu, Sung)

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

1. 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. 2. 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. 3. Communication with faculty regarding night-time contact with patients 4. 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. 5. 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. 6. 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. It may be advisable to limit vacation during the months of heavy R4 interviews. 7. 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. 8. 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. 9. 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).

Evaluation and Feedback

The OHNS Faculty on the Headmirror 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 laryngeal oncology

Resident Objectives: Be able to identify clinically suspicious lesions of the larynx and esophagus, 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. ACGME Competency Goals Patient Care Medical Knowledge Systems-Based Practice Patient Care Medical Knowledge Interpersonal and Communication Skills

Be able to acquire appropriate information to stage laryngeal 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. Patient Care Professionalism Systems-Based Practice

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. Professionalism

Practice-Based Learning and Improvement

Interpersonal and Communication Skills

Administer care for the post-operative oncology patient. Patient Care Medical Knowledge Be able to describe principles about and perform interventions for early laryngeal cancer. Patient Care Medical Knowledge

Be able to perform interventions for advanced laryngeal cancer. Patient Care Medical Knowledge

Goal 2: Be competent in evaluating and managing otolaryngology patients.

Resident Objectives: ACGME Competency Goals

Expand and refine evaluation and management skills of otolaryngology patients. Such knowledge should allow the R4 resident to confidently and independently care for otolaryngology patients by the end of the year.

Expand participation to include a leadership role in teaching conferences facilitating the learning of the junior residents and medical students. Expand knowledge of Otolaryngology literature for diseases and disorders of the larynx and sleep surgery.

Understand the limits of surgical and medical treatment.

Understand indications for urgent operative decisions, such as a performing a surgical airway and decompressing an expanding neck hematoma Recognize and manage surgical risk-factors.

Administer care for the post-operative patient.

Expand the capacity to recognize and treat post-surgical complications effectively, and learn to recognize preoperative risk factors. Gain a healthy appreciation for the dangers inherent in medical intervention, and learn how to be appropriate in selecting patients for surgery.

Assume a leadership role in postoperative care of complications such as salivary fistula, wound infection, hematoma, cerebrospinal fluid leak, airway compromise, and hemorrhage. Teach the junior residents and medical students to manage these complications. Be able to successfully transition from supervision by faculty to primary decision making with faculty oversight. Medical Knowledge Patient Care

Practice-Based Learning and Improvement Interpersonal and Communication Skills Patient Care Medical Knowledge Practice-Based Learning and Improvement Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Practice-Based Learning and Improvement

Patient Care Practice-Based Learning and Improvement

Patient Care

Patient Care

Supervise presentation of complications on the service at monthly Morbidity and Mortality conference. Practice-Based Learning and Improvement

Demonstrate competence and organizational skills in directing the resident team in the daily management of in-house patients and OR activities. Demonstrate ability and commitment in the day-to-day informal teaching and mentoring of students and junior residents. Be able to competently supervise/assist junior residents performing common OTO/HNS surgical procedures. Be able to demonstrate excellent interpersonal skills, effectively setting the tone for other members of the resident team, clinical and non-clinical staff. Practice-Based Learning and Improvement

Practice-Based Learning and Improvement

Practice-Based Learning and Improvement

Professionalism

Goal 3. Airway. Be able to evaluate and form treatment plans for adults with airway obstruction due upper airway and tracheal lesions.

Resident Objectives: ACGME Competency Goals Be able to describe the anatomy, physiology, and pathophysiology of the larynx. Medical Knowledge Be able to recognize, describe and categorize stridor in adults. Know the most common causes of stridor and dyspnea in adults. Patient Care Medical Knowledge

Be able to describe the various methods for managing a complex airway patient (i.e. awake fiberoptic intubation, hi-flow nasal cannula, jet ventilation, laryngeal mas airway, rigid bronchoscopy, awake tracheostomy); their indications and their possible complications. Be able to discuss routine care of a tracheostomy and describe how to recognize tracheostomy obstruction or decannulation. Be able to educate a patient about the risks/benefits and care of a tracheostomy. Be knowledgeable about how to obtain the needed tracheostomy related equipment for patient use at home.

Be familiar with the principal lesions that can affect vocal fold function in adults (i.e. papilloma, polyp, nodule, cancer). Be able to identify the various methods for laryngeal framework surgery (e.g. thyroplasty, arytenoids adduction); their indications and their possible complications. Patient Care

Patient Care Medical Knowledge Interpersonal and Communication Skills Systems-Based Practice Patient Care Medical Knowledge Patient Care Medical Knowledge

Know the instrumentation used to resect laryngeal lesions (i.e. endoscopic scissors, graspers, laser). Patient Care

Goal 4. Videostroboscopy. Be able to utilize and to interpret videostroboscopy in the diagnosis of laryngeal disorders.

Resident Objectives: ACGME Competency Goals Be familiar with the setup and technique of videostroboscopy. Patient Care Medical Knowledge

Understand the various components of laryngeal function which can be assessed with videostroboscopy (ie, vocal fold waveform, amplitude, glottic gap, etc). Patient Care Medical Knowledge

Recognize the characteristic features of various disorders as diagnosed by videostroboscopy (ie, nodules, polyps, cysts, granulomas, spasmodic dysphonia).

Patient Care Medical Knowledge Goal 5. Sleep Medicine. Be able to effectively evaluate and treat a patient with a sleep related breathing disorder. Resident Objectives: ACGME Competency Goals

Know the indications for PAP therapy, and different modalities including CPAP, auto PAP, BiPAP, Auto BIPAP, AVAPS, and ASV.

Evaluate and stimulate PAP compliance through clinical history and data downloaded from PAP machine.

Understand and be able to recommend methods to improve PAP compliance including mask refitting, use of EPR, referral to behavioral desensitization.

Be able to integrate with other members of a sleep center, and know how to adequately refer patients for medical, dental, and behavioral management of sleep disorders. Be able to analyze data from the history, physical examination, sleep test, nasal endoscopy, drug induced sleep endoscopy, and imaging tests and identify who will benefit from some sort of therapy and which therapy should be recommended. Be able to select appropriate candidates for oral device therapy.

Be able to inform the patient about weight loss, behavioral and positional management of SRBD. Patient Care Medical Knowledge Patient Care Interpersonal and Communication Skills Patient Care Interpersonal and Communication Skills Systems-Based Practice Patient Care Systems-Based Practice Patient Care Medical Knowledge

Patient Care Medical Knowledge Patient Care Interpersonal and Communication Skills

Be able to ethically and thoroughly provide all available data to patients and help him/her make the best possible decision on surgical care of OSA. Patient Care Interpersonal and Communication Skills Professionalism

Understand the indications, role and realistic goals of surgery. Be able to perform an adequate psychosocial assessment and explain why no surgical intervention may be the best choice for some patients. Be able to formulate an independent plan for surgical management of obstructive sleep apnea. Performing septoplasty, turbinate reduction, uvulopalatopharyngoplasty. Understand the indications, techniques, benefits and risks of sleep surgery involving the facial skeleton (maxillomandibular advancement, maxillary expansion/DOME, genioglossus advancement). Performing critical parts of the procedure. Incorporate virtual surgical planning. Understand the inclusion criteria of hypoglossal nerve stimulation. Performing critical Parts of the procedure. Understand the activation protocol after implantation. Patient Care Interpersonal and Communication Skills Professionalism Medical Knowledge Patient Care Medical Knowledge

Patient Care Medical Knowledge

Understand and describe risks and complications of OSA surgery, including voice and swallowing changes, complex pain management, facial paresthesias, infection, need for HGNS explant, facial profile and cosmetic changes and need for revision surgery. Be able to effectively and compassionately counsel patients of these details. Effectively and comprehensively manage primary inhouse, post-operative and consult patients with obstructive sleep apnea with the junior and senior residents. Demonstrate appropriate surgical technique for uvulopalatopharyngoplasty, be able to perform most of the cervical approach in hypoglossal nerve stimulation cases. Be able to perform Lefort osteotomies during maxillomandibular advancement Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Patient Care Medical Knowledge Systems-Based Practice Patient Care Medical Knowledge

Goal 6. Improve competency in the performance of laryngology, sleep, and general otolaryngology surgeries

Resident Objectives: Be adept in performing the following procedures: · Diagnostic endoscopy · Operative microlaryngoscopy · Tracheotomy · Salivary gland resections ACGME Competency Goals Patient Care

· Endoscopic dilatation and CO2 laser resection for subglottic stenosis and posterior glottic stenosis · Uvulopalatopharyngoplasty and its multiple modifications · Tongue surgery-volume reduction and/or tongue suspension/suture Become increasingly skilled in performing the following procedures: · Neck Dissection · Laryngectomy (total and partial) · Laryngopharyngectomy · Parotidectomy · Thyroidectomy · Parathyroidectomy · Type I thyroplasty · Arytenoid adduction · Cricotracheal resection · Tracheal resection · Maxillomandibular advancement, maxillary expansion/DOME, genioglossus advancement · Hypoglossal nerve stimulator implant Know the indications, perioperative care, expected outcomes and possible complications for all procedures listed above. Patient Care

Patient Care

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

Goal 6. 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). ACGME Competency Goals Patient Care

Systems-Based Practice

Professionalism Patient Care

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.

Prepare and guide junior residents presentation at weekly Head and Neck Case conference. 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. Interpersonal and Communication Skills

Systems-Based Practice

Professionalism

Professionalism

Interpersonal and Communication Skills

Professionalism

Practice-Based Learning and Improvement

Medical Knowledge

Systems-Based Practice

Medical Knowledge

Practice-Based Learning and Improvement