Goals and Objectives PGY 2/3: SHC Scalpel Service

Goal 2: Otolaryngology (“Scalpel”) Rotation: To begin to develop otolaryngology surgical skills. Resident Objectives: ACGME Competency Goals

• Resident will know the names of common surgical instruments. Patient Care

• Resident will learn basic suturing and knot tying techniques. • Resident will know how to set up the OR for routine otolaryngology cases. • Resident will learn the basic techniques of Direct laryngoscopy, Esophagoscopy, Bronchoscopy. • Resident will gain experience by assisting with surgical procedures. • Resident will be introduced to flexible laryngoscopy. Goal 3: Otolaryngology (“Scalpel”) Rotation: To begin to organize a plan for a research project during residency. Resident Objectives: ACGME Competency Goals • Meet with at least three faculty members about possible research projects during the otolaryngology research rotation in the PGY3 year. Professionalism

Goals and Objectives PGY 2/3: 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)

Rotation Specifics

9. 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. 10. 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. 11. Communication with faculty regarding night-time contact with patients

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. 12. 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. 13. 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. 14. 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. 15. 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. 16. 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). 17. The resident is required to attend the Thursday H&N teaching conference (H&N team). At this conference, the PGY-2 will present a case assigned by the chief resident and know the tumor stage and basic management strategies. 18. The resident will also attend H&N 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 area of head and neck oncology.

Resident Objectives: Be able to accurately stage cancers of the head and neck.

Develop an understanding of the role of chemotherapy and radiation therapy in the treatment of head and neck cancer. ACGME Competency Goals Medical Knowledge

Patient Care Medical Knowledge Patient Care Medical Knowledge

Begin to be able to formulate a treatment plan for head and neck tumors with supervision, and be able to effectively counsel patients regarding treatment options including risks associated with surgical treatment. Progress in ability to counsel patients regarding head and neck cancer risk factors.

Develop an understanding of the role of surgery in the treatment of squamous cell carcinoma of the head and neck. Begin to understand the appropriate surgical procedures for the treatment of head and neck cancers.

Be able to work-up and treat patients with thyroid and parathyroid diseases.

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. Interpersonal and Communication Skills Practice-Based Learning and Improvement

Patient Care Medical Knowledge Interpersonal and Communication Skills 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

Be able to recognize the histopathologic appearance of common head and neck neoplasms, including parotid and thyroid pathology. Medical Knowledge

Goal 2. Consults in an adult tertiary care hospital. Learn about the most common consults requested from other medical and surgical services regarding laryngeal problems in adults.

Resident Objectives:

Be the initial contact person for all consults from other SHC services and the emergency department.

Perform initial evaluation of all consult patients. ACGME Competency Goals

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

Be familiar with the SCH electronic medical record (EPIC) and be able to access information appropriately. Understand the importance of confidentiality in patient medical records. Evaluate consult patients with senior resident or fellow and faculty member and communicate recommendations and plan to primary team. Consistently demonstrate courtesy when interacting with clinical and non-clinical staff members.

Perform a literature search to learn more about unusual patient problems. Professionalism Systems-Based Practice Patient Care Medical Knowledge Systems-Based Practice Interpersonal and Communication Skills Medical Knowledge Practice-Based Learning and Improvement

Create a complete and coherent consultation note and dictate it in a timely fashion. This objective applies to all patients seen in the clinic setting as well as the outpatient setting.

Interpersonal and Communication Skills Professionalism Utilize translation services to communicate with non-English speaking patients as needed. Interpersonal and Communication Skills Systems-Based Practice

Demonstrate effective time-management skills. Practice-Based Learning and Improvement Professionalism

Follow-up on consult patients as needed. Patient Care Systems-Based Practice Professionalism

Prepare and present at the weekly Head and Neck Case conference. Medical Knowledge Systems-Based Practice

Goal 3. Expand ability to perform head and neck surgical procedures

Resident Objectives: ACGME Competency Goals Be able to competently and efficiently perform mid-level procedures with attending assistance Patient Care such as: • Direct laryngoscopy and biopsy • Flexible and rigid esophagoscopy. • Tonsillectomy • Tracheostomy • Panendoscopy • Submandibular gland excision • Excision of congenital cysts

• Resection of small carcinomas (e.g. tongue, floor of mouth) • Resection of melanoma of the head and neck • Sentinel lymph node biopsy • Skin graft and flap reconstruction of head and neck defects • Assist with neck dissections and begin to understand the anatomy and principles governing neck dissections

Goal 4. Improve general otolaryngology knowledge

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 to set-up and use the facial nerve integrity monitor. Demonstrate competence in the safe and appropriate use of various lasers. 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. 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. ACGME Competency Goals Patient Care Medical Knowledge Patient Care Patient Care Patient Care Systems-Based Practice Patient Care Systems-Based Practice Professionalism Systems-Based Practice Professionalism

Professionalism Practice-Based Learning and Improvement