Goals and Objectives PGY 4: SHC Specialty Service

Goals and Objectives PGY 4: SHC Specialty Service

Competency-based Goals and Objectives Goal 1. Consults in an adult hospital. Continue to learn about consults requested regarding otologic problems.

Resident Objectives: ACGME Competency Goals

Be the backup or initial contact person for consults from other SHC services and the emergency department. Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Systems-Based Practice

Perform initial or backup evaluation for consult patients. Patient Care Medical Knowledge

Be familiar with the subtleties of the SHC electronic medical record (Epic) and be able to access information appropriately. Understand the importance of confidentiality in patient medical records. Patient Care Professionalism Systems-Based Practice

Evaluate consult patients with chief resident, 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, and teach other residents, and medical students. Patient Care Medical Knowledge Systems-Based Practice Interpersonal and Communication Skills Medical Knowledge Practice-Based Learning and Improvement

Create or review 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

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

Attend multidisciplinary Skull Base Tumor rounds.

Systems-Based Practice

Goal 2. Chronic Otitis Media. Screen, diagnose and manage patients with symptoms secondary to their chronic ear infections

Resident Objectives: ACGME Competency Goals Be able to describe the anatomy, physiology, and pathophysiology of the middle ear and mastoid, and the variations seen that may influence optimal treatment options. Medical Knowledge Take a refined history focused on issues related to recurrent and chronic ear infections. Patient Care Describe and assess the use of diagnostic tests for assessing otologic disease (e.g. CT and MRI imaging, audiology, tympanometry). Refine efficiency in ordering tests. Patient Care Medical Knowledge Systems-Based Practice

Be able to assess the external and middle ear on exam, including the use of the binocular microscope and otoendoscopy. Refine the interpretation of clinical findings to formulate a treatment plan. Differentiate middle ear from external ear disease. Patient Care

Patient Care

Be able to counsel parents about the pathophysiology of conditions associated with chronic otitis, its risks, and treatment options. Understand the indications for surgical intervention, its risks and potential complications. Understand how history and anatomy influence surgical treatment planning. Be able to counsel parents about the risks and benefits of tympanomastoid surgery, and obtain informed consent for planned procedure. Know the perioperative management and expected postoperative course of patients who undergo tympanomastoid surgery. Be able to answer the majority of postoperative questions/ concerns. Patient Care Interpersonal and Communication Skills Patient Care Medical Knowledge Professionalism Interpersonal and Communication Skills Patient Care

Be able to safely and efficiently perform the majority of tympanomastoid surgery including mastoidectomy, transcanal procedures, ossiculoplasty, etc. Refine comfort with mastoidectomy and bone removal techniques; increase safety and efficiency. Be able to assess outcomes over time and formulate plans based on the evolution of the underlying disease.

Goal 3. Vertigo. Be able to evaluate and treat peripheral vestibular disease.

Resident Objectives: Be able to describe the anatomy, physiology, and pathophysiology of the peripheral vestibular system, and how it impacts clinical presentation. Be able to take a history related to balance and vertigo. Formulate a directed and practical differential diagnosis. Know how to perform clinical examination of patients with vestibular complaints. Differentiate peripheral from central pathology. Patient Care

Patient Care

Patient Care

ACGME Competency Goals Medical Knowledge

Patient Care Interpersonal and Communication Skills Patient Care

Understand treatments available for acute vestibular dysfunction in the clinic and emergency room.

Refine ability to discuss factors involved in vertigo and balance dysfunction with patients and families. Patient Care Medical Knowledge Patient Care Medical Knowledge Interpersonal and Communication Skills

Be able to counsel parents about the various treatment options available for management of Meniere’s disease, paroxysmal positioning vertigo, and vestibular neuronitis, superior semicircular canal dehiscence, etc. Discuss medical vs surgical approaches, and formulate an understanding of the role of surgery in these disorders. Patient Care Interpersonal and Communication Skills

Be able to interpret vestibular function tests, and use them in forming a treatment plan. Patient Care Medical Knowledge

Be able to discuss care of vertigo patients with providers from other specialties to formulate a care plan involving a number of disciplines. Understand the role of otolaryngologist and other specialists in the management of vestibular disorders. Patient Care Interpersonal and Communication Skills

Be familiar with the surgical management of peripheral vestibular disease, and be able to perform the majority of the steps necessary for their successful completion. Patient Care Medical Knowledge Interpersonal and Communication Skills

Goal 4. Hearing Loss

Resident Objectives: ACGME competency goals Be able to obtain a comprehensive hearing loss history and formulate a treatment plan. Patient Care Refine the ability to recognize, describe and categorize acquired and congenital hearing loss. Patient Care Medical Knowledge

Know the most common causes of sensorineural vs conductive hearing loss. Patient Care Medical Knowledge

Perform an efficient physical examination for hearing loss, including tuning fork exam, otomicroscopy, cranial nerve exam, pneumo-otoscopy, and know whn additional testing is needed Patient Care

Understand audiometric testing, and how to fully interpret their findings to direct care. Refine the ability to discuss patient data with audiologists to optimize care.

Patient Care Medical Knowledge Understand the basics of hearing aid types, styles, limitations, and the fitting process. Patient Care Medical Knowledge

Understand the options of surgical correction of conductive hearing loss (stapedectomy, ossiculoplasty) including their indications, limitations, and the relevant anatomic variations that could be encountered intraoperatively. Patient Care

Gain additional familiarity with intraoperative evaluation of ossicular chain mobility, and understand the reconstructive options that are available for a given patient. Be able to place the majority of ossicular prostheses. Patient Care

Be able to assess patients for possible cochlear implantation. Be able to discuss the indications, surgery, postoperative expectations, and need for rehabilitation services. Be able to perform the majority of cochlear implantation with intraoperative supervision. Patient Care Medical Knowledge Interpersonal and Communication Skills

Goal 5. Neurotology. Diagnose and manage patients with skull base disease

Resident Objectives: ACGME Competency Goals

Refine the understanding of skull base anatomy to understand the influence of anatomic and pathologic variability on treatment options and patient care. Be able to obtain a detailed history related to extra-axial neoplasms and other lesions of the internal auditory canal, cerebellopontine angle, temporal bone and posterior fossa. Incorporate relevant patient data into an efficient and optimized care plan. Understand the surgical anatomy, signs, symptoms and clinical diagnosis of lesions of the petrous apex. Refine an understanding for which lesions require immediate treatment, and which do not. Understand the interpretation of radiologic studies used to diagnose lesions of the posterolateral skull base. Be able to combine different modalities in formulating a diagnosis. Be able to effectively use ancillary tests (e.g. angiography, electrodiagnostic studies, nuclear studies) to evaluate skull base lesions. Be able to evaluate a patient with vestibular schwannoma in the clinic, and formulate a reasonable treatment plan based on findings, radiology, and patient preferences. Medical Knowledge

Patient Care Interpersonal and Communication Skills

Patient Care Medical Knowledge

Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge

Be able to recognize complications of cranial base surgery, including vascular injury, spinal fluid leak, cranial neuropathy, infection, and CNS injury. Recognize the causative factors, and formulate a basic management plan. Refine the ability to collaborate at a high level with a multidisciplinary team to provide comprehensive care for patients with skull base lesions.

Understand the options for benign lesions of the postero-lateral skull base including watchful waiting, focused radiation, and microsurgical resection. Have a basic understanding of treatment planning for stereotactic radiosurgery. Patient Care Medical Knowledge

Patient Care Medical Knowledge Interpersonal and Communication Skills Patient Care Medical Knowledge

Goal 6. Audiology. Understand the methods available to test the hearing, and how to interpret the tests.

Resident Objectives: Be familiar with the indications for various audiometric tests including pure-tone testing, word recognitions scores, reflex testing, tympanometry). Understand how to use these tests efficiently in the context of clinical findings. ACGME competency goals Patient Care Medical Knowledge

Be familiar with interpreting audiometric testing, including their accuracy, reliability, and impact on clinical care. Be able to perform routine tympanograms and audiograms.

Understand specialized electodiagnostic studies and their indications (including ABR, ECOG, VEMP, rotational chair, posturography testing, VNG, etc). Understand how they can guide further treatment.

Goal 7. Facial Nerve

Resident Objectives: Understand the surgical anatomy of the facial nerve and its common disorders, including their natural history, clinical presentation, evaluation and treatment. Be able to identify and decompress the intratemporal facial nerve with supervision as clinically indicated. Be able to perform the majority of facial nerve neurorrhaphy, including donor graft harvest.

Goal 8. General Otology

Resident Objectives Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge

ACGME competency goals Patient Care Medical Knowledge Patient Care Medical Knowledge

ACGME Competency Goals

Be able to obtain an appropriate history regarding external ear disease. Understand cutaneous disorders that may be related and the indications for biopsy. Patient Care Interpersonal and Communication Skills

Become more comfortable with clinical otologic procedures including myringotomy, and intratympanic injections. Be familiar with local anesthetic used for outpatient otologic procedures. Patient Care Medical Knowledge

Be able to discuss the basics of intratympanic treatment, including the procedure, its risks, benefits, and expectations.

Patient Care Medical Knowledge Interpersonal and Communication Skills Be able to effectively evaluate and treat the majority of patients complaining of tinnitus. Patient Care Medical Knowledge

Refine the approach to patients with otalgia, including an understanding of when to involve consultation for non-otologic etiologies. Patient Care Medical Knowledge

Refine the interaction with other related consult services for patients with otologic complaints. Patient Care Interpersonal and Communication Skills

Further develop an understanding of and sensitivity to the impact of cultural, economic and ethnic factors in the doctor-patient relationship and the delivery of otologic care. Develop an improved understanding of one’s own abilities and limitations including awareness of signs of fatigue. Professionalism Systems-Based Practice Professionalism

Become a more 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. Professionalism Practice-Based Learning and Improvement

Develop an understanding of OHNS coding and compliance issues in otology/ neurotology. Professionalism Systems-Based Practice

Goal 9. Nasal cavity and sinuses. Diagnose and manage patients with nasal problems.

Resident Objectives Be familiar with the EMR at Stanford (EPIC) to confidentially access appropriate patient information, past culture results, pathology reports and past imaging studies. ACGME Competency Goals Patient Care Professionalism Systems-Based Practice

Evaluate consult patients with sinonasal disorders with the senior residents and faculty. Be able to document and communicate recommendations and plan with the primary team in a professional and courteous manner.

Patient Care Medical Knowledge Systems-Based Practice Interpersonal and Communication Skills Know the anatomy, pathophysiology, and development of the nasal cavity and sinuses. Medical Knowledge Perform literature searches to investigate common and rare patient presentations, and to obtain evidence for current practice paradigms in patient care. Medical Knowledge Practice-Based Learning and Improvement Professionalism

Understand principles and utility of CT versus MRI imaging of the sinuses. Understand and describe anatomic variations of the 4 pairs of paranasal sinuses, patterns of uncinate process attachment and sinus drainage patterns. Medical Knowledge Interpersonal and Communication Skills

Be able to obtain a detailed history related to the nose and nasal problems related to sinus disease and allergic rhinitis. Perform safe, informative routine office nasal endoscopy with 0 degree and 30 degree rigid endoscopes. Access and understand AAO descriptive guidelines for acute, subacute and chronic sinusitis, and know the major and minor symptoms associated with diagnosis of sinusitis. Evaluate patients with chronic sinusitis with and without polyposis – and distinguish which patients may require surgery or medical therapy. Patient Care Interpersonal and Communication Skills Patient Care

Medical Knowledge Systems-Based Practice Patient Care Medical Knowledge Professionalism

Be able to describe and recognize complications of acute sinusitis.

Identify the signs and symptoms and differences between allergic rhinitis and acute/chronic sinusitis.

Patient Care Medical Knowledge Patient Care Medical Knowledge Understand indications for safe intranasal office biopsy. Patient Care Medical Knowledge Be proficient with the evaluation and management algorithms for treating epistaxis. Patient Care Medical Knowledge Understand options for treatment of nasal septal deviation and turbinate hypertrophy. Patient Care Medical Knowledge

Learn the assembly of equipment needed to perform nasal endoscopy, and intraoperative image guidance. Complete basic aspects of endoscopic approaches to the nasal cavity – including use of zerodegree and 30 degree endoscopes, safely navigating the nasal cavity with mucosal preserving technique, performing septoplasty, turbinate reduction, maxillary antrostomy, and anterior ethmoidectomy.

Goal 10. Understand the basics of the aesthetic patient consultation

Patient Care Medical Knowledge Patient Care

Medical Knowledge

Resident Objectives: ACGME Competency Goals

Understand and be able to perform psychological assessment for potential aesthetic surgery patients. Medical Knowledge Patient Care

Describe how to perform outpatient filler or botulinum toxin injections. Know literature regarding efficacy of facial rejuvenation procedures. Understand basic medical photography. Medical Knowledge Medical Knowledge Medical Knowledge

Goal 11. Understand the approach to the rhinoplasty patient

Resident Objectives: ACGME Competency Goals Understand and provide psychological assessment for potential rhinoplasty patients. Medical Knowledge Patient Care

Understand anatomy of the internal and external nasal valve and repair. Know literature regarding efficacy of nasal surgical procedures. Understand basic aesthetic nasal analysis.

Goal 12. Understand the approach to the facial trauma patient

Resident Objectives: Medical Knowledge Medical Knowledge Medical Knowledge

ACGME competency goals Be able to assess and perform soft tissue repair. Medical Knowledge Patient Care Understand pathophysiology of facial fractures and provide effective plan of care. Medical Knowledge Patient Care

Understand the biomechanics of fixation for fractures

Know literature regarding facial trauma. Medical Knowledge Patient Care Medical Knowledge Patient Care

Goal 13. Understand the approach to the facial nerve trauma patient

Resident Objectives: Be able to explore the extratemporal facial nerve. Be able to discuss options for treatment of facial nerve paralysis. ACGME Competency Goals Medical Knowledge Medical Knowledge Patient Care Interpersonal and Communication Skills