Stanford OHNS 2026-27 Residency Handbook by Stanford OHNS

RESIDENTHANDBOOK

2026-2027

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

JacquelynCallander,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

KatieHohenberger,MD

FloydChristopherHolsinger, MD

PeterH.Hwang,MD

RobertK.Jackler, MD

NancyJiang,MD

MichaelJ.Kaplan,MD

GraceKim,MD

PeterJ.Koltai,MD

JakeLee,MD

JenniferLee,MD

WilliamLewis,MD

DáibhidÓMaoiléidigh,PhD,MS

PedroMartinsGomesdeOliveira,MD

I-Fan(Ted)Mau,MD,PhD

KaraMeister,MD

UchechukwuMegwalu,MD,MPH

LloydMinor,MD

SamP.Most,MD

EricNash,MD

JayakarNayak,MD,PhD

TeresaNicolson,PhD

BrianNuyen,MD

LisaOrloff,MD

ZaraPatel,MD

PeterPellionisz,MD,PhD

Jon-PaulPepper,MD

NathanReticker-Flynn,PhD,S.M.

AnthonyRicci,PhD

DouglasSidell,MD

DavudSirjani,MD

AlyssaSmith,MD

HeatherStarmer,MA

KristenSteenerson,MD

JohnSunwoo,MD

TristanTham,MD

MaiThyTruong,MD

TulioValdez,MD,MSc

NneomaWamkpah,MD

Fellows&ClinicalInstructors

Pediatrics–NadaAli,MD&PerlaVillamor,MD

FacialPlastic–StevenLosorelli,MD,MS&SheranSeneviratne,MBBS,MS

Laryngology–MaxwellScher,MD

Rhinology–LiritLevi,MD,MarnJoonPark,MD,JoshuaKaiXunTay, MBBS,MMed, MRCS,PhD&AllenZhou,MD

Sleep–AlaaAlanazi,MBBS&DorMaayan,MD

Head&Neck–AlyssaCivantos,MD,MS &ChrisChoi,MD

Otology-Neurotology–TracyCheng,MD,MS,AnaMarijaHalvorson,MD&Peter Pellionisz,MD,PhD

Research–NesrineBenkafadar,PhD

AffiliatedFaculty

SantaClaraValleyMedicalCenter

JuliaNoel,MD(Sectionchief)

KimberlyShepard, MD

MicahSaste,MD

AmandaMuñoz,MD

MishaAmoils,MD

HarishDharmarajan,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: OtolaryngologydepartmentatSantaClaraValleyMedicalCenter

VA: OtolaryngologydepartmentatVeteransAffairsPaloAltoHealth CareSystem

KP: KaiserPermanenteSantaClara

MF: MiniFellowship

Float: Chiefresidentrotationtocoveradultservicesasneeded

Rad/Res: Radiology(neuroradiology)/Research/Headmirror

CR: ConsultrotationforPGY2residents

Anes*: Anesthesia,StanfordHealthCare

ED*: EmergencyDepartment,StanfordHealthCare

Plastics*: PlasticSurgery,StanfordHealthCare

SICU* StanfordHealthCareIntensiveCareUnit

SCV

GS*: GeneralSurgery,SantaClaraValleyMedicalCenter

GS*: GeneralSurgery,VeteransAdministrationPaloAlto

ACSDay*: GeneralSurgery,StanfordHealthCare

*PGY1rotationswithGeneralSurgeryDepartment

2026-27OHNSResidentsRotationSchedule

5. PolicyonResidentPromotion

Stanfordisfortunatetoattractthehighestcaliberofresidentsinthenation.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.

Ifaresident’sperformanceisidentifiedasdeficientinoneormoreMilestonesorCore Competencies,theymaybegivenawrittenwarningandstartedonaninformalremediation process.Iftheresidentdemonstratesasubstantialdeficiency,orfailstocorrectanidentified deficiency,theymaythenbeplacedonFormalRemediationforaperiodofatleastthree months.Aremediationplanwillbedevelopedtoaddressanydeficienciesintheresident’s performance.Resourceswillbegiventohelptheresident,whichmayincludementoring, coaching,counselling,alearningevaluation,and ameetingwiththeDesignatedInstitutional Official(DIO).Ifinsufficient progressismadeafterthreemonths,remediationmaycontinue ortheresidentmayenterProbation.Thisperiodofrobationwilllastatleastthreemonths

andwillbeaccompaniedbyadetailedplantoaddressanydeficienciesintheresident’s performance.

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.

Meaningfulevaluationofthefacultyandtheprogramisacriticalaspectoftheresidency 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.

MentorshipCohorts

ResidentMentors

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

Classbeginning2025

YasminEltawil–VarunSagi

SorayaFereydooni–MonicaBodd

SabrinaMaoz–ShannonWu

MarkNyaeme –PeterMoon

Hong-Ho(Jason)Yang–MichaeleFrancescoCorbisiero

Classbeginning2026

GraceFassina–LekhaYesantharo

BeauIdler–MichaelCorbisiero

MelissaLee–UcheEzeh

SaiMaddineni–PatrickKiessling

MadelineOlson–BrookeWarren

AnthonyTang–DavidGrimm

10. AcademicCurriculum

RequiredAssignments

Thefollowingisalistoftheprinciplerequiredprojectsandtalksduringthecourseofthe residency:

Allfiveyearsofresidency

❑ OtolaryngologyIn-trainingExam

❑ Temporalbonelab

PGY2

❑ Researchproposal,dueatsemi-annualmeetingwithprogramdirector orassociate programdirector inJanuary/FebruaryandreviewedwiththeResidentResearch Supervisor,Dr.Finegersh,inMarch.

❑ ResidencyResearchSymposiumPresentation

PGY3

❑ ResidencyResearchSymposiumPresentation

❑ AbstractsubmissiontotheBayAreaResidencyResearchSymposium

❑ QualityImprovementProject –submissiontotheGME’sAnnualQualityImprovement andPatientSafetySymposium

PGY4

❑ ResidencyResearchSymposiumPresentation

PGY5

❑ GrandRounds

❑ ResidencyResearchSymposiumPresentation

11. DescriptionofAcademicContent,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 expected toparticipateintheformalTemporalBoneLabsessionsor practicedrillinginthe temporalbonelabontheirowntomeetrequiredcompetencies. Seeappendix(Temporal BoneLab) formoreinformation. TheQualityImprovementCurriculum,whichincorporatesa year-longgroupprojectisarequirementofallresidentsintheirPG3year.

TheuseoflaptopsisnotpermittedduringGrandRounds.

ThePGY5chiefresidentswillbeassignedtogiveonegrandroundssessionduringtheyear. Thetopicisofthechiefresident’schoosing,butthepresentationisexpected tocoveratopic indepth,aswouldbeexpectedforajobinterviewpresentation.

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

Allresidentsarerequiredtocompleteanallergycourseeitheronlineorinpersonatsome pointduringtheirresidency.Inaddition,allresidentsmustspendaminimumof twohalfdaysintheAllergyClinictogainhands-onexperiencewithskintesting. ContactDr.Meng Chenatmengchen@stanford.eduatleastonemonthinadvancetoscheduleyourclinictime. TheserequirementscanbecompletedinanyPGYyear,butatriptoattendthe American AcademyofOtolaryngicAllergyBasicCourseinAllergy&Immunologyisorganizedforthe PGY3classeachyear.IfaresidentcannotattendduringthiscourseduringPGY3,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)

• AnnualEducationRetreat

• ResidencyAnnualProgramEvaluation/Retreat(firstMondayinJune)

AnnualIn-trainingExam

Allresidents,includingthePGY1residents andresidentsintheirdedicatedresearchyearsof theCSTPtrack,arerequiredtositforthein-trainingexam,administeredthefirstSaturdayof March. Residentswhoachievescoresinthe7th-9th groupstanineswillreceive aprizeof$500 foracademicpurposes.Thoseinthebottomthreestanineswillberequiredtosubmita writtenstudyplantotheprogramdirectorandtheirassignedmentor,andtomeetwiththeir mentoronaquarterlybasistodiscussprogress.

ResidencyResearchSymposium

Everyyear,ongraduationFriday,thedepartmenthostsaday-longsymposiumtoshowcase researchconductedbyresidentsoverthe year.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 andDr.Jiang,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.ResidenttraveltoAOCMFcourses(onceper academicyearperresident)willalsobe approvedwithadditionaldepartmentfundingiftheyareabletosecuregrantfundingto coverpartoftheexpenses.Traveltoothermeetingsmaybeapprovedonacase-by-case basisbytheprogramdirector.

Fundingapprovalwillrequirethatthefollowingthreecircumstancesexist:

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

Theworkmustbeoriginalandpresentedforthefirsttime and,thepresentationmustbe accompaniedbyamanuscriptthatissubmittedtoapeerreviewedjournalbeforethetimeof themeeting.

Inaddition,thedepartmentwillfundatriptoanacademicconferenceoftheresident’s choosingonceduringtheirresidencytenurewithouttherequirementofpresentingatthe meeting.

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).Residentarerequiredto usetheitinerary-forwardingserviceifflightsarenotbookedthroughthe Stanford Travelprogram,andprovidecomparisonpricingviaEgencia.

§ 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

PertheCBA,Housestaffarepermittedtotakeupto fourweeks(20days) ofpersonaltimeoff (PTO)withpayduringeachone-yearperiod.Vacationshouldbescheduledin1-weekblocks unlesspriorapprovalisobtainedfromtheprogramdirectorandtherotationdirector(for exampleif2weeksarerequestedtogetherorifapartialweekisrequested).Theexceptionto the1-weekblockruleis“terminalleave”attheendoftheacademicyearforthechief residents.Chiefresidentswhoaredepartingforfellowshipwillbeallowedtotake5personal days-offfromtheendofthecontract(June24)notcountinggraduationdayasaday-off. PersonaltimeoffmustberequestedandsubsequentlyapprovedthroughtheMedHub system.Additionally,Housestaffaregiven5SHCholidaysorfloatingholidayseachyear(at leasttwoofthedaysshouldbefromtheSHCholidaylist:New Year’sDay,MLKDay,Memorial Day,IndependenceDay,LaborDay,ThanksgivingDay,andChristmasDay). Stanford UniversityMedicalCenterbelievesthatpersonaltimeawayfromtheresidencyprogramis importanttothewelfareofhousestaff,sounusedpersonaltimeoffdoesnotaccumulate fromyeartoyearandthereisnoprovisiontopayinlieuoftimeoff.

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

So-called“terminalleave,”vacation duringthefinal5working-daysofresidency,willbe granted forresidentswhowillbepursuingafellowship outsideofStanfordtoallowhelpease thetransitionperiod.These5dayscounttowardsthe20daytotalofPTOallowedeachyear. Aresidentwhoistakingterminalleaveshouldnottakeanadditionalweekofvacationduring thesamerotationblock.

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. Residentworkhoursaremonitoredonaweeklybasis,andanypotentialissuesareaddressed 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(PGY2–3)toskipmorning roundsduringtheweek.

– Theseresidentsshouldalsoleavethehospitaleachdayassoonastheirclinical responsibilitiesarecompleted.

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

– TheSHCjuniorresidentorchiefshouldtakeoveranyremainingworktoallow fortheresidenttoleaveontime.

– Attendingsonweekendcallmustroundnolaterthan8:00am.

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,andeachresidentcoveringthefloor ghost 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,orinstitutehasdetermined thatthefundedconferenceor programhaseducationalmerit,d)therecipientisnotsubjecttoanyimplicitorexplicit expectationofprovidingsomethinginreturnforthesupport.

SOMfaculty,students,staffandtraineesshouldevaluatecarefullytheirattendanceat meetingsandconferencesthatarefullyorpartiallysponsoredorrunbyIndustrybecauseof thepotentialforperceivedorrealconflictofinterest.

20. StanfordDepartmentofOHNSGuidelinesforConsultations

Generalguidelinesforallconsults:

◼ Otolaryngologyisaservice-oriented specialtywhererelationshipswithpractitioners ofotherservicesareestablishedandmaintained.

◼ ALLconsultsshouldbeseenthedaytheyarereceivedunlessitislateinthedayand thereferringproviderexpresslystatesthatitisfinetoseethenextday.Iftheconsultis receivedbutnotseenonthatday,pleaseseetheconsultyourselfonthe followingday soanotherresidentisnotleftwithyourwork.

◼ 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 –evenonesthatare noturgent.

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

EmergencyDepartmentConsultations:

◼ Shouldbeseenwithin1hourofreceivingthecall(obviously,quickerforurgent consults)

◼ AlwayscheckoutwiththeEDphysician –donotleavewithouttalkingtothem.

ConsultsatSHC:

◼ TheConsultPGY2(andoccasionally1)servesasthefront-lineconsultresident.

◼ Consultswillbeaddedtotheteamofthestaffingattending(i.e.aconsult 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,includingthePGY1residents,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)orAndreyFinegersh(afinegersh@stanford.edu)residencyresearchcommitteefaculty,to discussresearchgoals.

• Twoweeksofthefour,theresidentwillbeassignedtotheHeadmirrorteamtoallowtheresidenttogainexperiencein flexiblelaryngoscopyintheVoiceandSwallowingClinic.

• Atleasttwohalf-daysaretobespentinneurologyclinic shadowingDr.KristenSteenerson(onMondays,Tuesdays, ThursdaysorFridays) andDr.RichardBaron(TuesdaysorThursdays).PleasecontactDr.Steenerson (ksteen@stanford.edu)andDr.Baron(rbaron2@stanford.edu)atleastonemonthinadvancetoarrange.

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

• Oneafternoon(WednesdayorFriday)aweekwillbespentinaudiology,primarilyattheStanfordEarInstituteatWatson Court.

• Afternoonsnotspentinaudiologyorneurologyaretobeutilizedtodevelopresearchplans.

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

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

Zoomatpresent(Zoominfoavailable onthemonthlyconferenceschedule)

LPCHConferenceRoom

Wednesday–NeuroradiologyFellows Conference 1:30PM

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

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

Radiologyreadouts:

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. PatientCare

 Understandtheprocessofobtainingasurgicalinformedconsent.

 Beabletocompleteathoroughclinicalnoteintheinpatientrecord.

 UnderstandNPOguidelines.

 UnderstandfluidmanagementintheNPOpatient.

 Understandthebasiclaboratoryandradiologictestsperformedforthepre-operativeand post-operativepatient.

 Understandthebasicsofnutritionalsupportforthesurgicalpatient.

 Understandoperativesterilityprinciples.

 Understandthediagnosisandbasicsofmanagementofsurgicalrelatedinfections.

 Understandtheguidelinesanduseofprophylacticantibiotics.

 Learnhowtoeffectivelyutilizethe“EPIC”computerizedmedicalrecord.

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:

 Understandthedifferenttypesofshock.

 Understandthevarioustypesofmonitoringcathetersandhowtointerpretthedata obtained

 Understandthebasicprinciplesofmechanicalventilation.

 Understandeffectivepreventivemeasuresfordeepveinthrombosisandpulmonary embolus.

 UnderstandthebasicsofEKGinterpretation

 Understandthebasicsofrenalphysiologyandelectrolytedisturbances.

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

MedicalKnowledge

 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.

 Knowappropriateindicationsforgeneralversuslocalversusregionalanesthesia.

 Knowtheimportantfeaturesofthemostcommonsurgicalanestheticsusedinthe operatingroom.

 Understandappropriatepreoperativetestsforpatientsundergoinganesthesia.

 Beabletointerprettheanesthesiarecord.

 Befamiliarwithvarioustypesofintraoperativemonitoring.

 Beabletoperformorotrachealintubation.

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

PatientCare

MedicalKnowledge

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

 Learnaboutoptionalcommunicationbetweenanesthesiaandsurgicalteams. PatientCare

Professionalism

Systems-BasedPractice

 Learnhowtoparticipateina“timeout”sessionandunderstandtheimportanceofsurgical checklists.

PatientCare

Systems-BasedPractice

GoalsofNeuroradiology/Audiology/Neurology/Laryngology/Researchrotation:Tobecomefacileatorderingandreadingimaging studiesoftheheadandneck,tounderstandthebasicsofaudiologyandvestibulartesting,becomefamiliarwithbasicneurological assessments,learntoperformbasiclaryngologicalexamandairwayassessment, andlearnthefundamentalsofconductingmedical research.

ResidentObjectives: ACGMECompetencyGoals

 KnowtheanatomyoftheheadandneckasseenonCTandMRI.

 Understandwhichtypeofimagingstudyisbestforwhichtypeofclinicaldisorder.

 Understandtheappearanceofcommonheadandneckdisordersasseenonradiologic images.

 Learnhowtobestinteractwithmembersoftheradiologydepartment.

 SpendatleasttwosessionsobservingaCT/MRItechnologisttodevelopfamiliaritywith scanningprocesses,radiationdosingandsafety.

 AttendOHNSandneuroradiologyeducationconferences

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

 Spendtimeinaudiologyaminimumof oneafternoon/weeklearningaboutaudiologic testingforallages,hearingaidsandcochlearimplants.

 Learnthebasicsofaudiologyevaluationinadults.Beabletoperformanaudiogram.

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

PracticeBasedLearning

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

 Learnandobservethetypesofaudiologictestinginchildren.

 Understandthetypesofnewbornhearingscreensandtheassociatedlawsregarding screening.

 Observethevarioustypesofvestibulartestingandunderstandwheneachtypeis indicated.

 Learntotakeadetailedvertigo/dizzinesshistory.

 Becomefamiliarwithhowtoconduct athoroughvestibularphysicalexam

 Begintounderstand theworkupofavestibularpatient

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

 Describevestibularpathologies,bothcentralandperipheral.

 Learnmanagementoptionsinthetreatmentofpatientswithdizziness.

 Attendorviewonlineresearchtrainingcourse

 Learntoperformflexibleanddirectlaryngoscopy.Begintounderstandtheassessmentof theairwayandairwaymanagement.

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

StanfordHealthCareHeadmirrorService

RotationDirectors: Laryngology SleepMedicine Comprehensive

C.KwangSung,MD,MS RobsonCapasso,MD UchechukwuMegwalu,MD,MPH kwangs@stanford.edu rcapasso@stanford.edu umegwalu@stanford.edu

WeeklySchedule

Monday Tuesday Wednesday Thursday Friday

MegwaluOR Capasso/OliveiraOR(RWC, 4th Mon)

Jiangclinic(RWC,2nd &4th Mon)

JiangOR(1st ,3rd ,and5th Mon starting8/26)

Nuyenclinic(RWC)

Oliveiraclinic1st and5th

MauOR(1st ,2nd &4th Mon starting8/26)

Thamclinic

MegwaluOR Jiangclinic(RWC,2nd &4th Mon)

JiangOR(1st ,3rd ,and5th Mon starting8/26)

Nuyenclinic(RWC)

MauOR(1st,2nd &4th Mon starting8/26)

MauOR(3rd Mon)

Thamclinic

SungORorprocedure clinic(RWC)

Mauclinic(RWC)

Capassoclinic(RWC)

Leeclinic(RWC)

Megwaluclinic

Sungclinic(RWC)

Mauclinic(RWC)

Oliveiraclinic(RWC)

CapassoOR Leeclinic

Thamclinic(southbay), OR5th Wed

LeeOR(alternateweeks)

JiangOR(300P5th Thur starting8/26)

Damroseclinic(RWC)

Capassoclinic(RWC)

Oliveiraclinic(RWC)

Megwaluclinic

Thamclinic(southbay, 2nd and4th Thur)

LeeOR(alternateweeks)

DamroseOR NuyenOR(1st Fri)

MauOR(3rd Fri)

SungOR(4th &5thFri)

ThamOR(3rd Fri)

OliveiraOR(2nd and5th Fri)

SungORorprocedure clinic(RWC)

Mauclinic(RWC)

Damroseclinic(RWC)

Capassoclinic(RWC)

Leeclinic(RWC)

Megwaluclinic

Sungclinic(RWC)

Mauclinic(RWC)

Oliveiraclinic(RWC)

CapassoOR Leeclinic

Thamclinic(southbay), OR5th Wed

LeeOR(alternateweeks)

JiangOR(300P5th Thur starting8/26)

Damroseclinic(RWC)

Capassoclinic(RWC)

Megwaluclinic

Oliveiraclinic(RWC)

Thamclinic(southbay, 2nd and4th Thur)

LeeOR(alternateweeks)

DamroseOR NuyenOR(1st Fri)

MauOR(3rd Fri)

SungOR(4th &5thFri)

OliveiraOR(2nd and5th Fri)

ThamOR(3rd Fri)

GoalsandObjectivesPGY1:SHCHeadmirrorService

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.Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

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

ResidentObjectives:

•Knowtheimportantaspectsofhistoryandphysicalexaminationoftheotolaryngology patient.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

•Begintounderstandthediagnosisandtreatmentofcommonotolaryngologicdisorders. PatientCare

MedicalKnowledge

•BecomefamiliarwiththeACGMEresidentcaselogsystem.

PatientCare

MedicalKnowledge

Systems-BasedPractice

•Demonstrateself-awarenessandtimemanagement/organizationalskills. Practice-BasedLearningandImprovement

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

ResidentObjectives:

ACGMECompetencyGoals

•Residentwillknowthenamesofcommonsurgicalinstruments. PatientCare

•Residentwilllearnbasicsuturingandknottyingtechniques.

•ResidentwillknowhowtosetuptheORforroutineotolaryngologycases.

•ResidentwilllearnthebasictechniquesofDirectlaryngoscopy,Esophagoscopy, Bronchoscopy.

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

•Residentwillgainexperiencebyassistingwithsurgicalprocedures.

•Residentwillbeintroducedtoflexiblelaryngoscopy andvideostroboscopy.

•Residentwilllearnbasicsofdissectionofsofttissueofthefaceandneck. GoalsandObjectives

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Capasso,Damrose,Lee, Jiang,Martins GomesdeOliveira,Mau, 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.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand.R2sandR3son call 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 surgicalservicesregardinglaryngealandgeneralotolaryngologyproblemsinadults.

ResidentObjectives:

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandtheemergency department.

Performinitialevaluationofallconsultpatientswhendesignatedandforalllaryngology consults.

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism

Systems-BasedPractice

PatientCare

MedicalKnowledge

PatientCare

BefamiliarwiththeSHCelectronicmedicalrecord(EPIC)andbeabletoaccess informationappropriately. Understandtheimportanceofconfidentialityinpatient medicalrecords.

Evaluateconsultpatientswithseniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon-clinicalstaffmembers.

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems.

Createacompleteandcoherentconsultationnoteanddictateitinatimelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

Utilizetranslationservicestocommunicatewithnon-Englishspeakingpatientsasneeded.

Demonstrateeffectivetime-managementskills.

Follow-uponconsultpatientsasneeded.

PrepareandpresentattheweeklyHeadandNeckCaseconference.

ResidentObjectives:

Beabletodescribetheanatomy,physiology,andpathophysiologyofthelarynx.

Takeahistorywithfocusedquestionsthatassistinthediagnosisofhoarseness.

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

Beableonphysicalexaminationtoassessabnormalitiesofthevocalfolds(ie,paralysis, benignandmalignantlesions).

Professionalism

Systems-BasedPractice

PatientCare

MedicalKnowledge

Systems-BasedPractice

InterpersonalandCommunicationSkills

MedicalKnowledge

Practice-BasedLearningandImprovement

InterpersonalandCommunicationSkills

Professionalism

InterpersonalandCommunicationSkills

Systems-BasedPractice

Practice-BasedLearningandImprovement

Professionalism

PatientCare

Systems-BasedPractice

Professionalism

MedicalKnowledge

Systems-BasedPractice

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Describehowtoidentifyaparalyzedvocalfold.

Beabletocounselpatients/parentsaboutthepathophysiologyofconditionsassociated withvocalfoldparalysis.

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

PatientCare

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

Beabletocounselparentsabouttherisksandbenefitsofvocalfoldmedialization. Professionalism

InterpersonalandCommunicationSkills

Knowtheperioperativemanagementandexpectedpostoperativecourseofpatientswho undergovocalfoldmedialization.

Beabletosafelyandefficientlyperformaflexiblenasolaryngoscopy and videostroboscopy.

Beabletodiscussthetreatmentofandprovidecaretopatientswithcomplicationsof laryngoscopy.

Goal3.Swallowing. Beabletoevaluateandtreatswallowingdisordersinadults.

ResidentObjectives:

Beabletodescribetheanatomy,physiology,andpathophysiologyofthepharynxand esophagus.

Beabletotakeahistoryrelatedtothepharynxandesophagusasregardsswallowing problems.

Understandtheavailabletreatmentsfordysphagia.

Beabletodiscusstheindications,risks,benefitsandalternativestodilationandto cricopharyngealmyotomy.

PatientCare

InterpersonalandCommunicationSkills

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

BefamiliarwiththeendoscopicandopenmethodsoftreatingZenker’sdiverticulum. PatientCare

MedicalKnowledge

Understandtheavailablebedsideandradiographicmethodsofassessingswallowing. PatientCare

Beabletodiscussandtreatcomplicationsfromesophagoscopy.

Goal4.Expandabilitytoperformsurgicalprocedures

ResidentObjectives:

Beabletocompetentlyandefficientlyperformmid-levelprocedureswithattending assistance

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: ACGMECompetencyGoals

Befamiliarwiththesleep/wakeneuralcentersandconnectionsassociatedwithnormal sleep/wakecycles.

Knowthesleepstagesandarchitecture.

MedicalKnowledge

Understandoptionsfortreatmentofnasalseptaldeviationandturbinatehypertrophy.. MedicalKnowledge

Goal6.Knowaboutcommonsleepdisordersandtheirconsequences

ResidentObjectives:

Beabletodefineanddescribethefollowingsleepdisorders:

 Sleeprelatedbreathingdisorders(SRBD)

 Insomnia

 Circadianrhythmsleepdisorders

 Hypersomnias,parasomniasandsleeprelatedmovementdisorders

 Insufficientsleepsyndrome.

PatientCare

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

Goal7.Knowhowtoobtainasleephistoryandcomprehensivephysicalexaminationinpatientswithsleepcomplaints

ResidentObjectives:

ACGMECompetencyGoals

Beabletoobtainasleephistoryincludingtheabilitytoidentifyassociatedcomorbiditiesfrompoorsleep:moodandcognitivedysfunction,hypertension,atrial fibrillation,cerebrovascularaccidents.

PatientCare

InterpersonalandCommunicationSkills

KnowtheEpworthsleepinessscaleandbeabletoadministerandinterprettheresults. PatientCare

InterpersonalandCommunicationSkills

BeabletoidentifycraniofacialandsofttissueabnormalitiesassociatedwithSRBD. PatientCare

InterpersonalandCommunicationSkills

Goal8.Understandtheoptionsforevaluatingpatientswithsleepdisordersandhowtointerprettheappropriateclinicalstudies.

ResidentObjectives:

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

Beableonapolysomnogramtoidentifyrespiratoryeventsincludingapneas/hypopneas, andhypoventilation.

Understandtheindicationsandinterpretationof druginducedsleependoscopy.

Understandtheuseofimagingstudies forpre-operativeplanninginpatientswithsleep disorders.

Goal9.Improvegeneralotolaryngologyknowledge

ResidentObjectives:

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

Learntoset-upandusethefacialnerveintegritymonitor.

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers.

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

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

ACGMECompetencyGoals

MedicalKnowledge

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

PatientCare

Systems-BasedPractice

PatientCare

Systems-BasedPractice

Professionalism

Systems-BasedPractice

Developanunderstandingofone’sownabilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

Professionalism

Practice-BasedLearningandImprovement

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

GoalsandObjectivesPGY4:SHCHeadmirrorService

Rotation Contacts and Scheduling Details

PleasecoordinateschedulesandcarewithAttendingSurgeons(Capasso,Damrose, Jiang,Lee,MartinsGomesdeOliveira,Mau, 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.TheR2shouldNOTbypassseniorresidentsandgo directlytotheattending.Thisisforteachingpurposes.

4. Residentsareexpectedtomakeentriesintomedicalrecordsfornight-timepatientcontacts.AnoteshouldbeenteredintoEpicfor eachcontactwithpatients.

5. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshouldanticipate andplaninadvancesothatcasescanbecoveredasmuchaspossible.Thismayrequireaskingresidentsfromotherservicestohelp. ItmaybeadvisabletolimitvacationduringthemonthsofheavyR4interviews.

6. Abriefoperativenoteshouldbeenteredwithinanhourofcompletionofthesurgerybytheresident.Dictationofoperative reports: within24hours.

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

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

EvaluationandFeedback

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

Competency-basedGoalsandObjectives

Goal1.Expandknowledgeintheareaoflaryngealoncology

ResidentObjectives:

Beabletoidentifyclinicallysuspiciouslesionsofthelarynxandesophagus,perform appropriatebiopsiesandimagingstudiestomakeadiagnosisinacosteffectiveand timeefficientmanner.

Understandriskfactorsforheadandneckcancer,beabletoassesspatientsforrisk factorsandbeabletocounselpatientsaboutmanagingtheriskfactors.

Beabletoacquireappropriateinformationtostagelaryngealcancers,topresentcases intheHeadandNeckTumorBoardandtodeterminethebesttreatmentmodalityor modalities.WhenpresentingthecasesinTumorBoard,up-to-dateliteraturewillbe usedtosupporttreatmentdecisions.

Beabletodiscussthetreatmentoptionswiththepatientandmaketheappropriate consultations(medicaloncology,radiationoncology,dentistry,speechpathology, physicaltherapy,nutrition,andorsocialwork)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

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

Beabletodescribeprinciplesaboutandperforminterventionsforearlylaryngeal cancer.

Beabletoperforminterventionsforadvancedlaryngealcancer.

Goal2: Becompetentinevaluatingandmanagingotolaryngologypatients.

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Expandandrefineevaluationandmanagementskillsofotolaryngologypatients. SuchknowledgeshouldallowtheR4residenttoconfidentlyandindependentlycare forotolaryngologypatientsbytheendoftheyear.

Expandparticipationtoincludealeadershiproleinteachingconferencesfacilitating thelearningofthejuniorresidentsandmedicalstudents.

ExpandknowledgeofOtolaryngologyliteraturefordiseasesanddisordersofthe 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 Quality Improvementconference.

Demonstratecompetenceandorganizationalskills indirectingtheresidentteamin thedailymanagementofin-housepatientsandORactivities.

Demonstrateabilityandcommitmentintheday-to-dayinformalteachingand mentoringofstudentsandjuniorresidents.

Beabletocompetentlysupervise/assistjuniorresidentsperformingcommon OTO/HNSsurgicalprocedures.

Beabletodemonstrateexcellentinterpersonalskills,effectivelysettingthetonefor othermembersoftheresidentteam,clinicalandnon-clinicalstaff.

Practice-BasedLearningandImprovement

PatientCare

Practice-BasedLearningandImprovement

Professionalism

Goal3.Airway.Beabletoevaluateandformtreatmentplansforadultswithairwayobstructiondueupperairwayandtracheal lesions.

ResidentObjectives:

Beabletodescribetheanatomy,physiology,andpathophysiologyofthelarynx.

Beabletorecognize,describeandcategorizestridorinadults. Knowthemost commoncausesofstridoranddyspneainadults.

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

Beabletodiscussroutinecareofatracheostomyanddescribehowtorecognize tracheostomyobstructionordecannulation.Beabletoeducateapatientaboutthe

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

risks/benefitsandcareofatracheostomy.Beknowledgeableabouthowtoobtainthe neededtracheostomyrelatedequipmentforpatientuseathome.

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

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

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

Systems-BasedPractice

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

Goal4.Videostroboscopy. Beabletoutilizeandtointerpretvideostroboscopyinthediagnosisoflaryngealdisorders.

ResidentObjectives: ACGMECompetencyGoals

Befamiliarwiththesetupandtechniqueofvideostroboscopy.

Understandthevariouscomponentsoflaryngealfunctionwhichcanbeassessedwith videostroboscopy(i.e.,vocalfoldwaveform,amplitude,glotticgap,etc).

Recognizethecharacteristicfeaturesofvariousdisordersasdiagnosedby videostroboscopy(i.e.,nodules,polyps,cysts,granulomas,spasmodicdysphonia).

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Goal5. SleepMedicine.Beabletoeffectivelyevaluateandtreatapatientwithasleeprelatedbreathingdisorder.

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,andimagingtestsandidentifywhowill benefitfromsomesortoftherapyandwhichtherapyshouldberecommended.

Beabletoselectappropriatecandidatesfororaldevicetherapy.

Beabletoinformthepatientaboutweightloss,behavioralandpositional managementofSRBD.

Beabletoethicallyandthoroughlyprovideallavailabledatatopatientsandhelp him/hermakethebestpossibledecisiononsurgicalcareofOSA.

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

Understandtheindications,techniques,benefitsandrisksofsleepsurgeryinvolving thefacialskeleton(maxillomandibularadvancement,maxillaryexpansion/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 oflaryngology,sleep,andgeneralotolaryngologysurgeries

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

· Hypoglossalnervestimulatorimplant

PatientCare

Knowtheindications,perioperativecare,expectedoutcomesandpossible complicationsforallprocedureslistedabove.

PatientCare

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare

Goal7. Beabletotakecareofpatientsinanethical,efficientandcaringmannerwithinthecurrentmedicalsystem

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

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

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandto complywithinsurancepayorregulations(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.Selectedclinicpatientswillevaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

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

ResidentObjectives:

•Knowtheimportantaspectsofhistoryandphysicalexaminationoftheotolaryngology 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.

Rotation Contacts and Scheduling Details

ACGMECompetencyGoals

Professionalism

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

RotationSpecifics

GoalsandObjectivesPGY3:SHCScalpelService

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. Each residentwillbeexpectedtopresentpatientstwiceatH&Ntumorboardduringtherotation.

EvaluationandFeedback

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

Competency-basedGoalsandObjectives

Goal1. Expandknowledgeinareaofheadandneckoncology.

ResidentObjectives:

Beabletoaccuratelystagecancersoftheheadandneck.

Developanunderstandingoftheroleofchemotherapy,radiationtherapy,and immunotherapyinthetreatmentofheadandneckcancer.

Begintobeabletoformulateatreatmentplanforheadandnecktumorswithsupervision, andbeabletoeffectivelycounselpatientsregardingtreatmentoptionsincludingrisks associatedwithsurgicaltreatment.

Adequatelyassessflapviabilityandrecognizevenouscongestionorarterialinsufficiency

Progressinabilitytocounselpatientsregardingheadandneckcancerriskfactors.

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. Learnaboutthemostcommonconsultsrequestedfromothermedicaland surgicalservicesregardingotolaryngologyproblemsinadults.

ResidentObjectives:

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandtheemergency department.

Performinitialevaluationofallconsultpatients.

BefamiliarwiththeSCHelectronicmedicalrecord(EPIC)andbeabletoaccessinformation appropriately. Understandtheimportanceofconfidentialityinpatientmedicalrecords.

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems.

Createacompleteandcoherentconsultationnoteanddictateitinatimelyfashion.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 reviewofallpatientimagingandattendanceatradiologyrounds.

Learntoset-upandusethefacialnerveintegritymonitor.

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers.

CompetencyGoals

PatientCare

MedicalKnowledge

PatientCare

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

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomplywith insurancepayorregulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sownabilitiesandlimitationsincludingawarenessof signsoffatigue.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

Systems-BasedPractice

PatientCare

Systems-BasedPractice

Professionalism

Systems-BasedPractice

Professionalism

Practice-BasedLearningandImprovement

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

GoalsandObjectivesPGY4:SHCScalpelService

Rotation Contacts and Scheduling Details

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

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.EachresidentwillbeexpectedtopresentpatientstwiceatH&Ntumorboardduringthe rotation.

EvaluationandFeedback

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

Competency-basedGoalsandObjectives

Goal1.Expandknowledgeintheareaofhead&necksurgery,aswellasgeneralconceptsinsurgicaloncology

ResidentObjectives:

Beabletoidentifyclinicallysuspiciouslesionsoftheheadandneck,performappropriate biopsiesandimagingstudiestomakeadiagnosisinacosteffectiveandtimeefficient manner.

Understandriskfactorsforheadandneckcancer,beabletoassesspatientsforriskfactors andbeabletocounselpatientsaboutmanagingtheriskfactors.

Beabletoacquireappropriateinformationtostageheadandneckcancers,topresent casesintheHeadandNeckTumorBoardandtodeterminethebesttreatmentmodalityor modalities. WhenpresentingthecasesinTumorBoard,up-to-dateliteraturewillbeused tosupporttreatmentdecisions.

Recognizeflapcomplications(flapfailure,salivaryfistula,hematoma)andinitiate appropriateintervention

ACGMECompetencyGoals

PatientCare

MedicalKnowledge

Systems-BasedPractice

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare

Professionalism

Systems-BasedPractice

Patientcare

MedicalKnowledge

Systems-basedpractice

Professionalism

Beabletodiscussthetreatmentoptionswiththepatientandmaketheappropriate consultations(medicaloncology,radiationoncology,dentistry,speechpathology,physical therapy,nutrition,andorsocialwork)basedonthepatient’sneedsandwishes.Thiswill requireconsiderationofthepatient’srightsandasensitivitytocultural,age,genderand disabilityissues.

Becomemorefamiliarwithablativeandreconstructiveoptions.

Understandtheroleofadjuvant andneoadjuvanttherapy.

Beabletowork-upandtreatpatientswiththyroidandparathyroiddiseases. Become familiarwiththeendocrinologyofthesedisordersandhowtodecidewhen interventionisappropriate.

Learnthefundamentalsofneckultrasound,toincludeoptimizationofmachinesettings andaccurateidentificationofpathology.

Beabletowork-upandtreatpatientswithmelanomaoftheheadandneck.

Beabletowork-upandtreatpatientswithsalivaryglandtumors.

PrepareandpresentattheweeklyHeadandNeckCaseconference orAttendingrounds.

Administercareforthepost-operativeoncologypatient.

Goal2.Improvecompetencyintheperformance ofheadandnecksurgeries

Practice-BasedLearningandImprovement

InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Systems-BasedPractice

Practice-BasedLearningandImprovement

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

PatientCare

MedicalKnowledge

Systems-BasedPractice

PatientCare

MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Beadeptinperformingthefollowingprocedures:

· Diagnosticendoscopy

· Operativemicrolaryngoscopy

PatientCare

· Tracheotomy

· Oralcavitycancerresections

· Removalofskincancers

· Sentinellymphnodebiopsy

Becomeincreasinglyskilledinperformingthefollowingprocedures:

· NeckDissection

· Laryngectomy(totalandpartial)

· Laryngopharyngectomy

· Compositeresection

· Regionalflapsforreconstruction

· Maxillectomy

· Parotidectomy

· Thyroidectomy

· Parathyroidectomy

Knowtheindications,perioperativecare,expectedoutcomesandpossiblecomplications forallprocedureslistedabove.

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers.

PatientCare

Goal4. Beabletotakecareofpatientsinanethical,efficientandcaringmannerwithinthecurrentmedicalsystem

ResidentObjectives:

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

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

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

ACGMECompetencyGoals

PatientCare

Systems-BasedPractice

Professionalism

PatientCare

InterpersonalandCommunicationSkills

Systems-BasedPractice

Professionalism

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sownabilitiesandlimitationsincludingawarenessof signsoffatigue.

Professionalism

InterpersonalandCommunicationSkills

Professionalism

Practice-BasedLearningandImprovement

PrepareandguidejuniorresidentspresentationatweeklyHeadandNeckCaseconference orAttendingrounds.

MedicalKnowledge

Systems-BasedPractice

MedicalKnowledge

Practice-BasedLearningandImprovement

Rotation Contacts and Scheduling Details

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

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