OHNS Resident Handbook 2022-2023

RESIDENTHANDBOOK 2022-2023

STANFORDUNIVERSITY SCHOOLOFMEDICINE

DepartmentofOtolaryngology Head&NeckSurgery

GoalsandObjectivesPGY2/3: PEDIATRICOtolaryngology

Goals

Goals

GoalsandObjectivesPGY1: SHCSpecialtyService

GoalsandObjectivesPGY2/3: SHCSpecialtyService 93

GoalsandObjectivesPGY4: SHCSpecialtyService

OTATIONBYRESIDENT..................................................................155 APPENDIXG RESIDENTPEEREVALUATIONFORM 158 APPENDIXH–EVALUATIONFORMOFRESIDENTBYSTAFF..........................................................................................161 APPENDIXI EVALUATIONFORMOFRESIDENTBYPATIENT 163 APPENDIXJ–OTOLARYNGOLOGYMILESTONES2.0.....................................................................................................165 APPENDIXK FACIALTRAUMACALLPOLICY..................................................................................................................166 APPENDIXL–MEDICINE/ENT/FACE/EDINTER-SERVICEAGREEMENT...................................................................168 APPENDIXM AFTERHOURSOUTPATIENTMEDICALADVICE......................................................................................171 APPENDIXN–PAGINGSYSTEM 172 APPENDIXO VERBALORDERSPROCESSCLARIFICATIONSFORNURSESANDPHYSICIANS 173 APPENDIXP–TEMPORALBONELAB 175 APPENDIXQ SHCINFECTIONCONTROL.......................................................................................................................177 APPENDIXR VAPAHCSENTRESIDENTHANDBOOK2022 2023 178

1. Introduction

TheStanfordDepartmentofOtolaryngology Head&NeckSurgeryisdedicatedtoproviding thehighestleveloftrainingto itsresidentsandfellows.

MISSIONANDPHILOSOPHY

• Providepatientcarewithbothexpertiseandcompassion

• Fosterdedicationtolife longlearningandteaching

• Excelatstate of theartmedicalcareforpatientswithotolaryngologicaldiseases

• Takeaninvestigativeapproachtothescientificandpolicyquestionsinmedicine

• Inventnewapproachestodiagnosis andtherapy

• Implementandoptimizeemergingtechnologies

• Beactiveworldcitizensintheprovisionofhealthcareto thosemostinneed

ThishandbookdescribespoliciesandproceduresassociatedwiththeOtolaryngology Head &NeckSurgeryresidency, aswellastheexpectationsforsuccessfulcompletionofthe program.Itisupdatedannually.

TheGraduateMedicalEducationOffice’sHouse StaffHandbookisavailablefordownload at: https://med.stanford.edu/gme/policy.html

2. StanfordUniversityOtolaryngologyFacultyRoster

Stanford

DepartmentChair KonstantinaM.Stankovic,M.D.,Ph.D.

ViceChair

PeterHwang,M.D. ResidencyProgramDirector C.KwangSung,M.D.,M.S. AssociateProgramDirector JenniferAlyono,M.D.,M.S. IramAhmad,M.D.,M.M.E. FredBaik,MD KarthikBalakrishnan,M.D.,MPH NikolasH.Blevins,M.D. RobsonCapasso,M.D. KayW.Chang,M.D. AlanCheng,M.D. EdwardJ.Damrose,M.D. ElizabethDiRenzo,Ph.D. VasuDivi,M.D. MatthewFitzgerald,Ph.D. NicolasGrillet,Ph.D. StefanHeller,Ph.D. FloydChristopherHolsinger,M.D. PeterH.Hwang,M.D. RobertK.Jackler,M.D. MichaelJ.Kaplan,M.D. PeterJ.Koltai,M.D. JenniferLee,M.D. StanleyLiu,M.D.,D.D.S. DáibhidÓMaoiléidigh,Ph.D.,M.S. KaraMeister,M D UchechukwuMegwalu,M.D.,MPH LloydMinor,M.D. SamP.Most,M.D. JayakarNayak,M.D.,Ph.D. TeresaNicolson,Ph.D. JuliaNoel,M.D. LisaOrloff,M.D. ZaraPatel,M.D. Jon PaulPepper,M.D. RobertRiley,M.D.,D.D.S AnthonyRicci,PhD PeterSantaMaria,MBBS,Ph.D. JohnShinn,M.D. GeorgeShorago,M.D. DougSidell,M.D. DavudSirjani,M.D. HeatherStarmer,M.A. KristenSteenerson,M.D JohnSunwoo,M.D. MaiThyTruong,M.D. TulioValdez,M.D.,MSc

Fellows&ClinicalInstructors

Pediatrics TaseerDin,MBChB&GraceKim,M.D. FacialPlastic KyleKimura,M.D. Laryngology AldenSmith,M.D. Rhinology MichaelChang,M.D.&MichaelYong,M.D.,MPH,MBA Sleep AhmedAlsayed,MBBS &VikramPadhye,MBBS,Ph.D. Head&Neck DaljitMann,M.D.&KatherineWai,M.D.

Otology PeterKullar,MBBChir,MA,Ph.D.&LindsayMoore,M.D.

AffiliatedFaculty SantaClaraValleyMedicalCenter

M.LaurenLalakea,M.D.(Sectionchief) KimberlyShepard,M.D. MicahSaste,M.D. AmandaMuñoz,M.D. MishaAmoils,M.D.

VeteransAdministrationPaloAlto DavudSirjani,M.D.(Chief) KyleKimura,M.D. JayakarNayak,M.D.,Ph.D. BohdanMakarewycz,M.D. HamedSajjadi,M.D. C.KwangSung,M.D.,M.S.

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. Once interviewsare conducted,decisionsaboutcandidateselectionaremadebyconsensusamong thefaculty. Approximately45invitationsforinterviewsareofferedfromamong morethan300applications.InterviewstakeplaceontwodaysinJanuary.

4.

OHNSResidentsRotationSchedule

5. PolicyonResidentPromotion

Stanfordisfortunatetoattractthehighestcaliberofresidentsinthenation.Itisexpected thateachresidenthasthenecessaryskillsandintellecttobepromotedthroughthe residency 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.

Residentsfailingtoachievetheminimallevelofcompetence asdeterminedbythe evaluationswillbegivenwrittennoticeofthatfact.Dependingonthenatureofthe deficiency,theymaythenbeplacedonprobation.Thisperiodofprobationwilllastatleast threemonthsandwillbeaccompaniedbyadetailedplan toaddressanydeficienciesinthe resident’sperformance.

Residentswhoareonprobationforaminimumofthreemonthsandwhohavenot successfullyimprovedtheirperformancetomeetatleasttheminimallevelofcompetence maybedismissed.

7. 360°Evaluations

Performanceevaluationsarecompletedbyvariousmembersofthehealthcareteam includingfaculty,staff(nurses,MAs,physicians’assistants,nursepractitioners,technicians, anesthesiologists,etc),patientsandpeers. Theseevaluationsaddressperformanceinthe corecompetenciesandaresenttoevaluatorsaftereveryrotation,includingtheresearch block.Evaluationsareconductedon lineviatheMedHubsystemtoassureanonymity.Inan efforttoobtaina360 degreeevaluation,patientsare alsorandomlyaskedtocompete evaluationsbasedontheirinteractionswithresidents.

Peerevaluationsareheldfromresident accessuntiltheendoftheyeartoprotectanonymity. However,atthesemi annualreviewmeeting,theprogramdirectorwillshareaggregated feedbackoftheseevaluationsverbally. Resident(s)withthehighestpeerratings for outstandingteachingwillbeawardedthe“ResidentTeacheroftheYear”awardattheendof theyear.Anawardwillalsobegivenfortheresidentrated highestasanoutstandingteam 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

BeginningJuly2020,thefacultymentoringprogramhasbeenrestructured.Ratherthan1:1 facultytoresidentpairings,residentsarenowassignedtocohortsoffivetosixresidents representingeachpost graduateyear,andthesecohortsareassignedto onefaculty member.

Thecohortswillmeetatleastthreetimesayearforactivities(egdinner,outings)withtheir mentors.

Thegoalsofthisprogram aretoencouragemoreroutineinteractions,developclosergroup dynamicsandfriendships,andfostersupportive socialandprofessionalnetworks.

Theresidentmayconsultthefacultymentorasneededonanyissueseitherprofessionalor personal.TheresidentshouldalsofeelfreetoconsulttheProgramDirectorregardingany suchsubjects.

Thefacultymentorswillfunctionasliaisonstotherestofthefacultyforissues regarding residentacademic,clinicalandoperative performanceaswellaswell being.

Group # Resident PGY Track Mentor 1 1 Losorelli 2 CT Orloff 2 Wei 3 CT 3 Munjal 4 T32 4 Soo 4 T32 5 Ayoub 5 CT 2 6 Kiessling 2 T32 Sunwoo 7 Fullerton 3 CT 8 Coughran 4 CT 9 Cohen 5 CT 10 Cooperman 1 CT 3 11 Ezzibdeh 2 CT Patel 12 Rahman 2 CT 13 Huang 3 CT 14 Howard 4 CT 15 SantaMaria 5 CT 16 Lee,Maxwell 1 CT 4 17 Park 3 T32 Divi 18 Azimzadeh 3 CT 19 Lee,YuJin 4 T32 20 Thai 1 CT

21 Nelson 1 CT

5 22 Belsky 2 CT Hwang 23 Diop 3 CT 24 Liu 4 CT 25 Oliveira 5 CT 26 Qian 5 T32 27 Mahajan 1 T32

ResidentMentors

Theotolaryngologypeer mentoringprogramwasstartedin2009toprovideaformalized careerandpersonalsupportsystemtojuniorresidents.Incominginternsarepairedwith mid levelresidents,basedonconsiderationoftheircommoninterests. Seniorresidentshavean opportunitytoofferprofessionalguidance,moralsupport,processdecisionsandthelike. Notificationsofthesepairingsaremadeinthespringpriortoincominginterns’arrivalto Stanford.

Classbeginning2021

MichaelBelsky JavierHoward RamiEzzibdeh JoanneSoo

PatrickKiessling JulienAzimzadeh StevenLosorelli GeorgeLiu ArifeenRahman AlannaCoughran

Classbeginning2022

ShaynaCooperman AliceHuang MaxwellLee MohamedDiop LaceyNelson ZoëFullerton ElishMahajan KiWan(Roy)Park AnthonyThai EricWei

10. AcademicCurriculum

RequiredAssignments

Thefollowingisalistoftheprinciplerequiredprojectsandtalksduringthecourseofthe residency:

Allfiveyearsofresidency

❑ OtolaryngologyIn trainingExam

❑ Temporalbonelab

PGY1

❑ RadiologycasepresentationassembledduringRadiology/ResearchRotation

PGY2

❑ Researchproposal,dueatsemi annualmeetingwithprogramdirectorin January/February.

❑ ResidencyResearchSymposiumPresentation

❑ RadiologycasepresentationforResidentEducation

PGY3

❑ ResidencyResearchSymposiumPresentation

❑ AbstractsubmissiontotheBayAreaResidencyResearchSymposium

❑ QualityImprovementProject

PGY4

❑ ResidencyResearchSymposiumPresentation

PGY5

❑ GrandRounds

❑ ResidencyResearchSymposiumPresentation

11. DescriptionofAcademicContent,Conferencesand Responsibilities

Residentsareresponsibleforcorelearningasoutlinedinthefollowingdocument: http://www.aboto.org/pub/Core%20Curriculum.pdf

Theacademiccurriculumisbasedonarotatingtwo yearcyclesothateachresidentis exposedtoeachtopicatleasttwiceduringhis/herresidency. WeeklyResidencyEducation conferencesareheldonMondays8:00 9:00AM. Residentsareexpectedtobeontimefor80% ofsessions(exceptforcasesofpre approved excusedabsences). ResidentsatSCVMCand VAPAwillbeexpectedtoparticipateviaZoomvideoconference.Attendancerecordswillbe tracked,andwillbereviewedbyresidentsandfaculty.

TheThursdayeveningconferences(GrandRoundsandQualityImprovement)beginat6:00 PM. Inaddition, therewillbeatleastonebookclub,and journalclubsareheldonweekday evenings(usuallyonMondays)fourtimesayear. Residentswillbeassignedtohelporganize thejournalclubs. Residentsareexpectedtopracticedrillinginthetemporalbonelabon theirowntomeetrequiredcompetencies. Seeappendix(TemporalBoneLab) formore information. TheQualityImprovementProject,whosecurriculumhasbeenredesigned,will bearequirementofallresidentsintheirPG3year.

TheuseoflaptopsisnotpermittedduringGrandRounds.

ThePGY5chiefresidentswillbeassignedtogiveonegrandroundssessionduringthe year.

AllresidentsrotatingatStanfordandLPCHareexpectedtoattendMondaymorning conferencefrom7:15 8:00AM.ThecoursesubjectsincludeNeurotologyRadiology, Laryngology,Rhinology,Trauma,SleepSurgery,andPediatricOtolaryngologyconference. TheresidentsrotatingatSCVMCandVAPAareexpectedtoparticipateintheMondaymorning conferencesviaZoomvideoconference.

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

Allresidentsarerequiredtocompleteanallergycourseeitheronlineorinpersonatsome pointduringtheirresidency.Inaddition,allresidentsmustspendaminimumof twohalf daysintheAllergyClinictogainhands onexperiencewithskintesting. ContactDr.Meng Chenatmengchen@stanford.eduatleastonemonthinadvancetoscheduleyourclinictime. TheserequirementscanbecompletedinanyPGYyear.Duetotravelrestrictions,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 Mondayconferencesat8:00AMandotherrequired conferences(egjournalclub,grandrounds,etc)andotherevents(residencymeetings, symposium,etc).

MandatoryEvents

Residentsarerequiredtobepresentforthefollowingannualevents.Vacationtimeshouldbe scheduledaccordingly:

• Residencygraduation

• ResidencyResearchSymposium

• In trainingexam(firstSaturdayofMarch)

• ResidencyAnnualProgramEvaluation/Retreat(usuallythefirstMondayinJune)

AnnualIn-trainingExam

Allresidents,includingthePGY1residents,includingresidentsintheirdedicatedresearch yearsoftheCSTPtrack,arerequiredtositforthein trainingexam,administeredthefirst SaturdayofMarch. Residentswhoachievescoresinthe7th 9th groupstanineswillreceive prizesof$500foracademicpurposes.Thoseinthebottomthreestanineswillberequiredto submitawrittenstudyplantotheprogramdirectorandtheirassignedmentor,andtomeet withtheirmentoronaquarterlybasistodiscussprogress.

ResidencyResearchSymposium

Everyyear,ongraduationFriday,thedepartmenthostsaday longsymposiumtoshowcase researchconductedbyresidentsovertheyear. Maximumtimeforthepresentationis7 minutes(withanadditionalthreeminutesofquestionandanswertime).Presentationsare judgedbyselectedfacultyandtheguestofhonorusingacriterion basedrubric,whichis providedtotheresidentsinadvance. PGY2 5arerequiredtogiveapresentation.Agrand prizeof$500inacademicfundsisgiventothebestoverallpresenter;therearetworunners up,receiving$250inacademicfundseachinthecategoriesofpresentationandcontent, respectively.

Tobeeligiblefortheseprizes,thematerialpresentedmustconstitute originalresearch conductedbytheresident(whichhasalsonotbeenpreviouslypresentedinyearspast,but mayhavebeenpresentedatanationalconferenceortheBayAreaResidencyResearch Symposium). Anabstractofthetalkisduetwoweeksbeforethe symposiumdate.

QualityImprovement(QI) Curriculum

EffectiveJuly1,2020,theQIcurriculumhasbeenrevamped. While itspurposeremainsthe same,thislearningrequirementhasbeenrestructured,isnowbeingoverseenbyDr.Karthik Balakrishnan,andisacollectiveratherthanindividualresidentprojectofPGY3’s.

TheaimoftheQIprojectistodevelopaplantosupportahospitalorclinicalperformance improvementorpatientsafetymeasureby:

• Reflectingonpracticeandpracticeanalysis

• Criticallyanalyzingthecurrentliterature

• Developingaplanforimplementationoftheproposedchange

• Developinganoutcomes’assessment(performancemeasure)

Itsoverallpurposeis tofosteranunderstandingofthecomplexitiesofhealthcaredelivery anddeveloptheskillstoaddressthemasisdescribedbythecorecompetency,Systems BasedPractice.

Theprogramisillustratedintheimagebelow. Workingsessionswilltakeplaceonweekday evening,fourtimesayearbetweenJulyandOctober. Thereaftertheteamwillmeetonits ownforcompletionoftheprojectinthefollowingJune.

NationalAcademicConferences

EveryattemptwillbemadetorelievethePGY2orPGY3residentsfromtheirclinical dutiesso thattheymayattendtheCombinedOtolaryngologySpringMeetingsponsoredbythe Departmentonetime.

Inaddition,allresidentswhohaveabstractsacceptedfor podiumpresentationataregional ornationalmeetingwillberelievedoftheirclinicalresponsibilitiestoattendthemeetingand presenttheirdata.PGY1 3’swhohaveabstractsacceptedforposterpresentationata regionalornationalmeetingwillberelievedoftheirclinicalresponsibilities,ifpossible,to attendthemeeting.Theywillbeeligibletoreceivefundingtooffsetthecostsofthemeeting (currentlysetatamaximumof$1,400perconference).Thereisnomaximumonthenumber ofconferencesaresidentmayattend.SeePolicyonResidentTravel.

FellowshipInterviews

Manyotolaryngologyresidentspursuefellowshipsinotolaryngologysubspecialtiesaftertheir residency.Thefacultyrecognizesthatresidentsneedtointerviewforthesefellowshipsand willmakeeveryefforttoreleaseresidentsfromtheirclinicaldutiessothattheymayattend theseinterviews. Fellowshipapplicantsareaskedtotrytominimizethedaysawayfromtheir rotationastheirabsenceplacesanundueburdenontheirfellowresidents.

12. ResidentTravelandConferenceFundingPolicy

Note:CheckthelatestupdatesonUniversity sponsored travel. Residenttraveltothefollowingscientificmeetingswillgenerallybeapprovedfor departmentalsupport:AmericanAssociationforResearchinOtolaryngology(ARO), CombinedOtolaryngologicalSpringMeetings(COSM),AmericanAcademyofOtolaryngology Head&NeckSurgeryAnnualMeeting(AAO HNS),andSectionMeetingsoftheTriological Society.Traveltoothermeetingsmaybeapprovedonacase by casebasisbytheprogram director.

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

Inaddition,theworkmustbeoriginalandpresentedforthefirsttime and,thepresentation mustbeaccompaniedbyamanuscriptthatissubmittedtoapeerreviewedjournalbefore thetimeofthemeeting.

MajorExpenseGuidelines(Note:BeginningJan.2022,residentsarealsorequiredtobooktheirtravel, includingflightandhotel,throughtheStanfordTravelprogram forsponsoredtrips):

• Roundtripairfarewillbereimbursedatthelowestavailablefare purchasedthroughEgencia: https://stanfordtravel.stanford.edu/(usingyourSUNetIDandpw).

• HotellodgingshouldalsobebookedthroughEgencia(exceptforconferencehotels) oruse theitinerary forwardingservice andratesshouldbereasonableandfollowuniversity’s Hotel LodgingRateGuidance: https://web.stanford.edu/group/fms/fingate/staff/travel/policy_notes/lodging.html

• Meetingregistrationreimbursementwillbebasedonearlypre registration,notat the door fees.

• Allgroundtransportationreimbursementisbasedonactualexpensesandshouldbe reasonableandnecessary.PerAGM5.4.2,useStanfordTraveltobookrentalcars.

• Mealswillnotbereimbursed.

• Totaldepartmentalreimbursementforagivenmeetingwillbea maximumof$1,400per domestictrip.

• Posterexpensesarereimbursedupto$100. Thisisconsideredseparatefromthetravel expenses.

NOTE:Theultimateapprovalofallresidenttravelatdepartmentalexpenseis atthe discretionoftheprogramdirectoranddepartmentalchair.Approvalofreimbursementfor travelnotmeetingtheabovecriteriamaybepossibleundercertaincircumstancesandwillbe evaluatedonacase by casebasis.

13. PersonalTime off

Housestaffarepermittedtotakeuptothreeweeksofpersonaltimeoffwithpayduringeach one yearperiod. Vacationshouldbescheduledin1 weekblocksunlesspriorapprovalis obtainedfromtheprogramdirectorandtherotationdirector(forexampleif2weeksare requestedtogetherorifapartialweekisrequested). Personaltimeoffmustberequested andsubsequentlyapprovedthroughtheMedHubsystem. StanfordUniversityMedicalCenter believesthatpersonaltimeawayfromtheresidencyprogramisimportanttothewelfareof housestaff,sounusedpersonaltimeoffdoesnotaccumulatefromyeartoyearandthereis noprovisiontopayinlieuoftimeoff.

Residentsshouldnotplanontakingvacationatthetimeofthein trainingexam,duringthe timeoftheAnnualProgramEvaluation(ResidencyRetreat),orduringtheweekofthechief residents’graduationdinnerandtheannualResidentResearchSymposium.Ataminimum, rotationdirectorsandthePDshouldbenotifiednolessthan2weeksbeforethe rotation starts. AlltimeoffmustberecordedinMedHub

So called“terminalleave,”vacationasthefinalweekofresidency,willbeconsideredonan individualbasisforresidentswhowillbepursuingafellowship. Aresidentwhoistaking terminalleaveshouldnottakeanadditionalweekofvacationduringthesamerotation block.

Timeoffforfellowship/jobinterviews

Residentsarenotpermittedtotakevacationinanyquarterinwhichtheywillbegonefor morethanfivedaysduetointerviews. Residentsmustreportthenumberofdaystheywillbe takingofftotheprogramdirector. Toavoidpatientcarecoverageissues,PGY2’sshouldtry nottakevacationwhenaresidentonthesamerotationisinterviewing.

14. ResidentWorkHoursandCall

TheDepartmentofOtolaryngology Head&NeckSurgeryiscommittedtofollowingthe currentACGMEpoliciesondutyhours.SeeGMEhandbookforpolicy.

Theresidentcallschedulewillbedeterminedbythechiefresidents. Firstcallisshared amongjuniorandseniorresidents;thesecondcallisbythechiefresident,orintheeventof thechiefresident’sabsence,bythemostseniorresidentontheservice.Thirdcallisstaffedby afacultymember.Recognizingtheindividualresidentcircumstancesandneedsand acknowledgingtheautonomyofthespecificsiteswithintheresidencyprogram,itis understoodthattheresidentswillbeallowedtodetermine theirowncallschedule,tothe extentthatthisdoesnotcreateanyunduehardshipforanyindividualresidentanditfollows theaboveguidelines.Asmuchaspossible,noresidentshouldbeoncall2weekendsinarow. Residentworkhoursaremonitored onaweeklybasisandanypotentialissuesareaddressed immediately.

Thefollowingguidelineswereadopted startingthe2020 2021AcademicYeartoaddressduty hourconcerns:

AllResidents:

• Alldayresidentsshouldleavethehospitalby9:00pmweekdays.Mayvoluntarilyelect tostay(ifworkingwithin80hours/week,1in7daysoffguidelines): tocontinuetoprovidecaretoasingleseverelyillorunstablepatient humanisticattentiontotheneedsofapatientorfamily toattenduniqueeducationalevents

• Thenightfloatresidentshouldactivelytakeoverdayresidents’work(e.g.,intheOR) toallowthemtoleaveby9:00pm,iftherearenoactiveconsults.

• Attendingorfellowtodictatecaseswhenfinishingafter9:00pmwhentheday residenthasleft.

JuniorResidents

• Chiefsmayallowjuniorresidentsoncallfortheweekend(PGY2 4)toskipmorning roundsduringtheweek. Theseresidentsshouldalsoleavethehospitaleachdayassoonastheirclinical responsibilitiesarecompleted.

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

– TheSHCjuniorresidentorchiefshouldtakeoveranyremainingworktoallow fortheresidenttoleaveontime.

– Attendingonweekendcallmustroundnolaterthan8:00am.

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 awarenessand contingencyplanning;S:Synthesisbyreceiver).

• Aftercheckingout,theJuniorresident(s)withtheghostconsultandfloorpagerswill reassignthepagerstotheon callresident. Inthemorningtheresidentassumingthe consultpagerwillreassignthe ghostpager,andeachresidentcoveringthefloorghost pagerswillreassignthepagers.

• Senior/chiefresidentscheckouttosenior/chiefresidentsregardingall unstable/concerningpatients.

• Facultymemberscheckoutallconcerningpatientstofacultymemberoncall.

16. OperativeCaseLogs

AllresidentsarerequiredtoenterdataontheirsurgicalcasesintotheACGMEsystemina timelymanner(everyweekrecommended,operativelogsmustbeup to dateatthetimeof thesemi annualresidentmeetingwith theprogramdirector orassociateprogramdirector.)

Residentsareresponsibleforkeepingtrackofthesurgicalcasesinwhichtheyparticipate.

AResidentSupervisorinstructs,andassistsasneeded,amorejuniorresidentduringa procedureduringwhichthejuniorresidentperformsgreaterthanorequalto50%ofthe operation,includingthekeyportion(s)oftheprocedure. Theattendingfunctionsasan assistantorobserver.

AResidentSurgeonperformsgreaterthanorequalto50%oftheoperation withthe attendingsurgeon(andresidentsupervisor,ifapplicable),includingthekeyportion(s)ofthe procedure.

AnAssistantSurgeonperformslessthan50%oftheoperation,orgreaterthanorequalto 50%oftheoperationbutnotthekeyportions(s)oftheprocedure.

ResidentsareresponsibleforenteringalldataintotheACGMEdatabase. Accuracyinthis endeavoriscritical,bothforjustifyingaresident’ssuitabilityforsittingfortheboard examination,aswellasaccuratelyreflectingthevolumeofsurgerydoneintheprogram.

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 bepostedtopasswordprotectedprofessionalsitesoncethedatahasbeende identified.

• 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. ItisstronglyadvisedthatnoformofpersonalgiftfromIndustrybeacceptedunder 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,orinstitutehasdeterminedthatthefundedconferenceor programhaseducationalmerit,d)therecipientisnotsubjecttoanyimplicitorexplicit expectationofprovidingsomethinginreturnforthesupport.

SOMfaculty,students,staffandtraineesshouldevaluatecarefullytheirattendanceat meetingsandconferencesthatarefullyorpartiallysponsoredorrunbyIndustrybecauseof thepotentialforperceivedorrealconflictofinterest.

20. StanfordDepartmentofOHNSGuidelinesforConsultations

Generalguidelinesforallconsults:

◼

◼

Otolaryngologyisaserviceorientedspecialtywhererelationshipswithpractitionersof otherservicesareestablishedandmaintained.

ALLconsultsshouldbeseenthedaytheyarereceivedunlessitislateinthedayand thereferringproviderexpresslystatesthatitisfinetoseethenextday. Iftheconsult isreceivedbutnotseenonthatday,pleaseseetheconsultyourselfonthefollowing daysoanother residentisnotleftwithyourwork.

◼

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.

◼ Alloutpatientcallsshouldbereturnedina timelyfashionandhaveatelephone encounterdocumentedintheappropriateEPIC.

◼ Thenightfloatresidentsshouldseeanddocumentallconsults evenonesthatarenot urgent.

◼

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

EmergencyDepartmentConsultations:

◼ Shouldbeseenwithin1hourofreceivingthecall(obviously,quickerforurgent consults)

◼ AlwayscheckoutwiththeEDphysician don’tleavewithouttalkingtothem.

ConsultsatSHC:

◼

◼

◼

TheConsultPGY2(and occasionally1)servesasthefront lineconsultresident.

Consultswillbeaddedtotheteamofthestaffingattending(ieaconsult 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

RotationContactsand SchedulingDetails

RotationDirector:KwangSung,MD,MS kwangs@stanford.edu

NOTE: Allresidents,includingthePGY1residents,willtakethein-trainingexamonthefirstSaturdayinMarch.

Rotationdetails:

Thedailyscheduleswillbedeterminedbythechiefresidents/facultyoneachindividualrotation. Whileonotherrotationsresidentsshouldattendtheresidenteducationsessionsforthatspecialty.Residentsshouldattend theOHNS educationsessionswhenfeasible.

Radiology/ResearchRotation

Thisrotationiscomprisedofneuroradiology,audiology,neurologyandresearch.

RotationContacts&Addresses

RotationDirectors: MrudulaPenta,MD(Neuroradiology) mrudula@stanford.edu

MattFitzgerald,PhD fitzmb@stanford.edu

Clinics:BesidesStanfordandLPCH,thelocationsforthisrotationinclude:

• 451ShermanAve

• Hoover2Pavilion(SNHC,StanfordNeurosciencesHealthCenter,213QuarryRd)

• VAPA

• StanfordEarInstitute(WatsonCourt)

RotationDetails:

• Oneweekbeforetherotation,residentistotouchbasewithDr.MrudulaPenta(mrudula@stanford.edu) fororientation planandsharingofdocuments,includingupcomingfaculty/fellowschedulesandconferenceschedules.

• Atleastoneweekbeforetherotation,residentistomakeanappointmentwithDrs.KaraMeister (meister4@stanford.edu)orIramAhmad(ahmadin@stanford.edu),residencyresearchcommitteefaculty,todiscuss researchgoals.

• Atleasttwohalf-daysaretobespentinneurologyclinic shadowingDr.KristenSteenerson(onMondays,Tuesdays, ThursdaysorFridays).PleasecontactDr.Steenerson(ksteen@stanford.edu)onemonthinadvancetoarrange.

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

• Oneafternoon(WednesdayorFriday)aweekwillbespentinaudiology,primarilyattheStanfordEarInstituteatWatson Court.

• Afternoonsnotspentinaudiologyorneurologyaretobeutilizedtodevelopresearchplans.

ResidentsarerequiredtocompletetheprojectspecifiedintheG&Os.

Conferences:InadditiontoattendingMondaymorningandThursdayafternoonOHNSconferences, theresidentisencouraged toattendthefollowingconferences,dependingonappropriatenessofcontent.CurrentschedulescanbeprovidedbyDr.Penta orbyneuroradiologyprogramcoordinatorMalikaCurry(mcurry18@stanford.edu).

Conference Time Locations

Mondays–NeuroradiologyFellows Conference

1:30PM

Tuesdays NeuroradiologyFellows Conference 7:30AM

Tuesdays NeurosurgerySkullBase Conference 5:30PM

Zoomatpresent(Zoominfo available onthemonthlyconferenceschedule)

Zoomatpresent(Zoominfoavailable onthemonthlyconferenceschedule)

Zoomatpresent(Zoominfoavailable onthemonthlyconferenceschedule)

Wednesday ThirdWedofmonth

(usually):PedsENTRadiologyConference 5-6pm LPCHConferenceRoom

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

Thursdays–Head&NeckTumorBoard 4:30-6:30PM Zoomatpresent(Zoominfoavailable onthemonthlyconferenceschedule)

Radiologyreadouts:

• 8:30amto11amislikelythebesttimeforaconsistentread outexperience

• Additionalone on oneRadiologyreviewtimeviaZoommightbeavailableduringpreparationoftheTuesdaySkullBase conference(Dr.Fischbein, fischbein@stanford.edu)ortheThursdayHeadandNeckTumorBoard(Dr.Fischbein,Dr. Penta,orDr.NancyPham, nanpham@stanford.edu)

• Observationofimage-guidedbiopsyproceduresmightalsobepossible –touchbasewithDr.Phamforthisoption

OtherResources:

• DiagnosticImaging:Head&Neck,3rd EditionbyKoch,etal

• ExpertDifferentialDiagnoses:Head&Neck,byHarnsberger

• AJNR(AmJNeuroradiol)SpecialCollections: linktoH+Npapers:http://www.ajnr.org/site/specCol/SpecColl7TOC.xhtml

note:aboundcopycanbeorderedfor$50ifonewantsto

Beabletoperformadetailedphysicalexamination. PatientCare MedicalKnowledge

Beabletowrite/dictateathoroughandsuccincthistory&physical. PatientCare

InterpersonalandCommunicationsSkills

Understandtheprocessof obtainingasurgicalinformedconsent. PatientCare Systems BasedPractice

Beabletocompleteathoroughclinicalnoteintheinpatientrecord.

InterpersonalandCommunicationsSkills PatientCare

UnderstandNPOguidelines. MedicalKnowledge PatientCare

UnderstandfluidmanagementintheNPOpatient. MedicalKnowledge PatientCare

Understandthebasiclaboratoryandradiologictestsperformedforthepre operativeand post operativepatient. MedicalKnowledge PatientCare

Understandthebasicsofnutritionalsupportforthesurgicalpatient. MedicalKnowledge PatientCare

Understandoperativesterilityprinciples. MedicalKnowledge PatientCare

Understandthediagnosisandbasicsof managementofsurgicalrelatedinfections. MedicalKnowledge PatientCare

Understandtheguidelinesanduseofprophylacticantibiotics. MedicalKnowledge PatientCare

Learnhowtoeffectivelyutilizethe“EPIC”computerizedmedical record. Systems BasedPractice

GoalforSurgicalIntensiveCareUnitrotation: Tounderstandthebasicsofcareforthecriticallyillsurgicalpatient.

ResidentObjectives: ACGMECompetencyGoals

Understandthedifferenttypesofshock. MedicalKnowledge

Understandthevarioustypesofmonitoringcathetersandhowtointerpretthedata obtained MedicalKnowledge

Understandthebasicprinciplesofmechanicalventilation. MedicalKnowledge

Understandeffective preventivemeasuresfordeepveinthrombosisandpulmonary embolus. MedicalKnowledge PatientCare

UnderstandthebasicsofEKGinterpretation MedicalKnowledge

Understandthebasicsofrenalphysiologyandelectrolytedisturbances. MedicalKnowledge

Understandthebasicsofpulmonaryphysiology MedicalKnowledge

Beabletomanagethenutritionalneedsofthesurgicalpatient. PatientCare

Learnaboutoptimalcommunicationbetweentheintensivistsandsurgicalteams. Professionalism Systems BasedPractice

GoalsofEmergencyMedicinerotation: Tounderstandthebasicsofcareintheemergencydepartment.

ResidentObjectives: ACGMECompetencyGoals

LearnabouttheprocessofE.D.triage. MedicalKnowledge PatientCare Systems BasedPractice

KnowhowtoevaluatethemostcommondisordersseeninE.D.patients. MedicalKnowledge PatientCare

LearnhowtoworkwiththeE.D.personnelandothermedicalprofessionalstoevaluateand treatpatients. MedicalKnowledge PatientCare Systems BasedPractice

Learnthebasicsoflacerationclosure. PatientCare MedicalKnowledge

GoalsforAnesthesiaRotation:Tobecomefamiliarwiththebasicsofanesthesiacare.

ResidentObjectives: ACGMECompetencyGoals

Knowbasiclaryngealanatomy. MedicalKnowledge

Knowappropriateindicationsforgeneralversuslocalversusregionalanesthesia. MedicalKnowledge PatientCare

Knowtheimportantfeaturesof themostcommonsurgicalanestheticsusedinthe operatingroom. PatientCare MedicalKnowledge

Understandappropriatepreoperativetestsforpatientsundergoinganesthesia. MedicalKnowledge PatientCare

Beabletointerpretthe anesthesiarecord. MedicalKnowledge

Befamiliarwithvarioustypesofintraoperativemonitoring. MedicalKnowledge PatientCare

Beabletoperformorotrachealintubation. PatientCare

Learnaboutoptionalcommunicationbetween anesthesiaandsurgicalteams. PatientCare Professionalism Systems BasedPractice

Learnhowtoparticipateina“timeout”sessionandunderstandtheimportanceofsurgical checklists. PatientCare Systems-BasedPractice

GoalsofNeuroradiology/Audiology/Neurology/Researchrotation:Tobecomefacileatorderingandreadingimagingstudiesofthehead andneck,tounderstandthebasicsofaudiologyandvestibulartesting,becomefamiliarwithbasicneurologicalassessments, andlearnthe fundamentalsofconductingmedicalresearch.

ResidentObjectives: ACGMECompetencyGoals

KnowtheanatomyoftheheadandneckasseenonCTandMRI. MedicalKnowledge PatientCare

Understandwhichtypeofimagingstudyisbestfor whichtypeofclinicaldisorder. MedicalKnowledge PatientCare

Understandtheappearanceofcommonheadandneckdisordersasseenonradiologic images. MedicalKnowledge PatientCare

Learnhowtobestinteractwithmembersofthe radiologydepartment. Systems-BasedPractice

SpendatleasttwosessionsobservingaCT/MRItechnologisttodevelopfamiliaritywith scanningprocesses,radiationdosingandsafety. MedicalKnowledge PatientCare

AttendOHNSandneuroradiologyeducationconferences

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

Spendtimeinaudiologyaminimumof oneafternoon/weeklearningaboutaudiologic testingforallages,hearingaidsandcochlearimplants.

Learnthebasicsofaudiologyevaluationinadults.Beabletoperformanaudiogram.

MedicalKnowledge PracticeBasedLearning PatientCare

MedicalKnowledge PatientCare

MedicalKnowledge PatientCare

MedicalKnowledge PatientCare

Learnandobservethetypesofaudiologictestinginchildren. MedicalKnowledge PatientCare

Understandthetypesof newbornhearingscreensandtheassociatedlawsregarding screening. MedicalKnowledge

Observethevarioustypesofvestibulartestingandunderstandwheneachtypeis indicated. MedicalKnowledge

Learntotakeadetailed vertigo/dizzinesshistory. MedicalKnowledge PatientCare

Becomefamiliarwithhowtoconduct athoroughvestibularphysicalexam MedicalKnowledge PatientCare

Begintounderstand theworkupofavestibularpatient MedicalKnowledge PatientCare Systems BasedPractice

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

Describevestibularpathologies,bothcentralandperipheral. MedicalKnowledge

Learnmanagementoptionsinthetreatmentofpatientswithdizziness. MedicalKnowledge PatientCare

Attendorviewonlineresearchtrainingcourse MedicalKnowledge

StanfordHealthCareHeadmirrorService

RotationDirectors: Laryngology Sleep

WeeklySchedule

AM

Comprehensive C.KwangSung,MD,MS RobsonCapasso,MD JenniferLee,MD kwangs@stanford.edu rcapasso@stanford.edu Jennifer.Y.Lee@stanford.edu

Medicine

Monday Tuesday Wednesday Thursday Friday

MegwaluOR Sungclinic Leeclinic CapassoOR(RWC)

SungOR Capassoclinic(RWC)

LeeOR Megwaluclinic

CapassoOR Leeclinic Liuclinic(RWC)

Damroseclinic Capassoclinic(RWC) Megwaluclinic

DamroseOR SungOR(4th &5thFri) Liuclinic(RWC)

PM Sungclinic Leeclinic

Sungprocedureclinic

Capassoclinic(RWC) LiuOR Megwaluclinic

CapassoOR Leeclinic Liuclinic(RWC)

Damroseclinic Capassoclinic(RWC) Megwaluclinic

DamroseOR SungOR(4th &5thFri) Liuclinic(RWC)

GoalsandObjectivesPGY1:SHCHeadmirrorService

ThePGY 1willparticipateinotolaryngologyroundsandunderthedirectionofthechief/seniorresidentwillberesponsibleforcare of inpatients.

Callduties:ThePGY1residentwilltakecallforin-housefloorpatientsfrom6:00amuntilafterrounds arecompleteandresidentsare 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:

•Knowtheimportantaspectsofhistoryandphysicalexaminationofthe otolaryngology patient.

ACGMECompetencyGoals

PatientCare MedicalKnowledge

•Begintounderstandthediagnosisandtreatmentofcommonotolaryngologicdisorders. PatientCare MedicalKnowledge

•BecomefamiliarwiththeACGMEresidentcaselogsystem. PatientCare MedicalKnowledge Systems BasedPractice

•Demonstrateself awarenessandtimemanagement/organizationalskills. Practice BasedLearningandImprovement

Goal2:Otolaryngology(“Headmirror”)Rotation:Tobegintodevelop otolaryngologysurgicalskills.

ResidentObjectives: ACGMECompetencyGoals

•Residentwillknowthenamesofcommonsurgicalinstruments. PatientCare

•Residentwilllearnbasicsuturingandknottyingtechniques.

•ResidentwillknowhowtosetuptheORforroutineotolaryngologycases.

•ResidentwilllearnthebasictechniquesofDirectlaryngoscopy,Esophagoscopy, Bronchoscopy.

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

•Residentwillgainexperiencebyassistingwithsurgicalprocedures.

•Residentwillbeintroducedtoflexiblelaryngoscopy.

•Residentwilllearnbasicsofdissectionofsofttissueofthefaceandneck.

Goal3:Otolaryngology(“Headmirror”)Rotation:Tobegintoorganizeaplanforaresearchprojectduringresidency.

ResidentObjectives:

•Meetwithatleastthreefacultymembersaboutpossibleresearchprojectsduringthe otolaryngologyresearchrotationinthePGY3year.

ACGMECompetencyGoals

Professionalism

GoalsandObjectivesPGY2/3:SHCHeadmirrorService

RotationContactsand SchedulingDetails

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Capasso,Damrose,Lee,Liu,Megwalu, Sung)

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow-up. The teamshouldestablishthispriortodischargebycallingtheclinicorcommunicatingwith theP.A.Thechiefresidentisexpected tobeteachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

• Communicationofsomesortisexpectedeachdaywith eachattending.Forsome,atextmessageisfine;for others,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 anticipateandplaninadvanceso thatclinicscanbecoveredasmuchaspossible.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 withthecoveringattendingor instructor(designatedbytheattendingpriortoleaving).

EvaluationandFeedback

TheOHNSFacultyontheHeadmirrorService(andselectedancillarymedicalpersonnel)willcompletewrittenevaluationsattheendof therotation.Selectedclinicpatientswillevaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberandthe rotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsand Objectives

Goal1. Consultsinanadulttertiarycarehospital. Learnaboutthemostcommonconsultsrequestedfromothermedicaland surgicalservicesregardinglaryngeal and generalotolaryngologyproblems inadults.

ResidentObjectives:

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandtheemergency department.

ACGMECompetencyGoals

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Professionalism Systems-BasedPractice

Performinitialevaluationofall consultpatientswhendesignatedandforalllaryngology consults.

BefamiliarwiththeSHCelectronicmedicalrecord(EPIC)andbeabletoaccess informationappropriately. Understandtheimportanceofconfidentialityinpatient medicalrecords.

Evaluateconsultpatientswith seniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon-clinicalstaffmembers.

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems.

PatientCare MedicalKnowledge

PatientCare Professionalism Systems BasedPractice

PatientCare MedicalKnowledge Systems BasedPractice

InterpersonalandCommunicationSkills

MedicalKnowledge

Createacompleteandcoherent consultationnoteanddictateitinatimelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

Practice BasedLearningand Improvement

InterpersonalandCommunicationSkills Professionalism

Utilizetranslationservicesto communicatewithnon-Englishspeakingpatientsasneeded. InterpersonalandCommunicationSkills Systems BasedPractice

Demonstrateeffectivetime managementskills. Practice BasedLearningand Improvement Professionalism

Follow uponconsultpatientsasneeded. PatientCare Systems-BasedPractice Professionalism

PrepareandpresentattheweeklyHeadandNeckCaseconference. MedicalKnowledge Systems BasedPractice

Goal

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyofthelarynx. MedicalKnowledge

Takeahistorywithfocusedquestionsthatassistinthediagnosisofhoarseness. PatientCare Describetheuseofdiagnostictestsforassessinghoarseness(e.g.airwayfilms,sleep studies,laryngealendoscopy). PatientCare MedicalKnowledge

Beableonphysicalexaminationtoassess abnormalitiesofthevocalfolds(ie,paralysis). PatientCare

Describehowtoidentifyaparalyzedvocal fold. PatientCare

Beabletocounselpatients/parentsaboutthepathophysiologyof conditionsassociated withvocalfoldparalysis.

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

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Beabletocounselparentsabouttherisksandbenefitsofvocalfoldmedialization. Professionalism

InterpersonalandCommunicationSkills

2. Hoarseness. Screen,diagnoseandmanagepatientswithsymptomssecondarytovocalfold/laryngeal pathology.

Knowtheperioperativemanagementandexpectedpostoperativecourseofpatientswho undergovocalfold medialization.

PatientCare

Beabletosafelyandefficientlyperformaflexiblefiberopticnasolaryngoscopy. PatientCare

Beabletodiscussthetreatmentofandprovidecaretopatientswithcomplicationsof laryngoscopy. PatientCare

Goal

3.Swallowing. Beabletoevaluateandtreatswallowingdisordersinadults.

ResidentObjectives:

Beabletodescribetheanatomy,physiology,andpathophysiologyofthepharynxand esophagus.

Beabletotakeahistoryrelatedtothepharynxandesophagusasregardsswallowing problems.

InterpersonalandCommunicationSkills

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

Understandtheavailabletreatmentsfordysphagia. PatientCare MedicalKnowledge

Beabletodiscussthe indications,risks,benefitsandalternativestodilationandto cricopharyngealmyotomy. PatientCare

BefamiliarwiththeendoscopicandopenmethodsoftreatingZenker’sdiverticulum. PatientCare MedicalKnowledge

Understandtheavailable bedsideand radiographicmethodsofassessingswallowing. PatientCare

Beabletodiscussandtreatcomplicationsfromesophagoscopy. PatientCare

Goal4.Expandabilitytoperformsurgical procedures

Resident

Objectives: ACGMECompetencyGoals

Beabletocompetentlyandefficientlyperformmid-levelprocedureswithattending assistance PatientCare suchas:

• Directlaryngoscopy

• Flexibleandrigid Esophagoscopy.

• Injectionlaryngoplasty

• Tonsillectomy

• Septoplasty

• Turbinatereduction

• Tracheostomy

• Panendoscopy

• Submandibularglandexcision

• Excisionofcongenitalcysts

• Eustachiantubedilation

• Resectionofsmallcarcinomas(e.g.tongue,floorofmouth)

Goal5.SleepMedicine. Knowaboutnormalsleep/wakeneurobiologyandrespiratoryphysiology

ResidentObjectives: ACGMECompetencyGoals

Befamiliarwiththesleep/wakeneuralcentersandconnectionsassociatedwithnormal sleep/wakecycles. MedicalKnowledge

Knowthesleepstagesandarchitecture. MedicalKnowledge Understandoptionsfortreatmentofnasalseptaldeviationandturbinatehypertrophy.. MedicalKnowledge

PatientCare

Goal6.Knowaboutcommonsleepdisordersandtheirconsequences

ResidentObjectives: ACGMECompetencyGoals

Beabletodefineanddescribethefollowingsleepdisorders: MedicalKnowledge

Sleeprelatedbreathingdisorders(SRBD) PatientCare Insomnia

Circadianrhythmsleepdisorders Hypersomnias,parasomniasandsleeprelatedmovementdisorders

Insufficientsleepsyndrome.

Goal7.Knowhowtoobtainasleephistoryandcomprehensivephysicalexaminationinpatientswithsleepcomplaints

ResidentObjectives: ACGMECompetencyGoals

Beabletoobtainasleephistoryincludingtheabilitytoidentifyassociatedco morbiditiesfrompoorsleep:moodandcognitivedysfunction,hypertension,atrial fibrillation,cerebrovascularaccidents.

PatientCare

InterpersonalandCommunicationSkills

KnowtheEpworthsleepinessscaleandbeabletoadministerandinterpretthe results. PatientCare

InterpersonalandCommunicationSkills

BeabletoidentifycraniofacialandsofttissueabnormalitiesassociatedwithSRBD. PatientCare

InterpersonalandCommunicationSkills

Goal8.Understandtheoptionsfor evaluatingpatientswithsleepdisordersandhowtointerprettheappropriateclinicalstudies.

ResidentObjectives: ACGMECompetencyGoals

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

MedicalKnowledge

Beableonapolysomnogramtoidentifyrespiratoryeventsincludingapneas/hypopneas, RERAsandhypoventilation. MedicalKnowledge

Understandtheindicationsandinterpretationofthemultiplesleeplatencytest. MedicalKnowledge Understandtheuseofimagingstudiesinpatientswithsleepdisorders.

Goal9.Improvegeneralotolaryngologyknowledge

MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceinthe interpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

PatientCare MedicalKnowledge

Learntoset upandusethefacialnerveintegritymonitor. PatientCare Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare

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

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

PatientCare Systems BasedPractice

PatientCare Systems-BasedPractice

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Professionalism

Professionalism Systems BasedPractice Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodsto appraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

Professionalism

Practice BasedLearningand Improvement

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

GoalsandObjectivesPGY4:SHC HeadmirrorService

RotationContactsand SchedulingDetails

PleasecoordinateschedulesandcarewithAttendingSurgeons (Capasso,Damrose,Lee,Liu,Megwalu,Sung)

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

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow up. Theteam shouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobe teachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatientsafterrounds/weekends:

• Communicationofsomesortisexpectedeachdaywith eachattending. Forsome,atextmessageisfine;forothers,aphonecall. Atthestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

• Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatient thatthey willcheckwiththeattending.

3. Communicationwithfacultyregarding night-timecontactwithpatients

Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcalltheir chiefresidenttoevaluate,whoshouldnotifythefellow,andthentheattending.TheR2shouldNOTbypasssenior residentsandgo directlytotheattending. Thisisforteachingpurposes.

4. Residentsareexpectedtomakeentriesintomedicalrecordsfornight timepatientcontacts.AnoteshouldbeenteredintoEpicfor eachcontactwithpatients.

5. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshouldanticipate andplaninadvancesothat casescanbecoveredasmuchaspossible. 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. Dailyfeedback onphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1.Expandknowledgeintheareaof laryngealoncology

ResidentObjectives: ACGMECompetencyGoals

Beabletoidentifyclinicallysuspiciouslesionsofthe larynxandesophagus,perform appropriatebiopsiesandimagingstudiestomakeadiagnosisinacosteffectiveand timeefficientmanner.

PatientCare MedicalKnowledge Systems BasedPractice Understandriskfactorsforheadandneckcancer,beabletoassesspatientsforrisk factorsandbeabletocounselpatientsaboutmanagingtheriskfactors.

PatientCare MedicalKnowledge

Interpersonaland Communication

Skills

Beabletoacquireappropriateinformationtostage laryngealcancers,topresentcases intheHeadandNeckTumorBoardandtodeterminethebesttreatmentmodalityor modalities. WhenpresentingthecasesinTumorBoard,up to dateliteraturewillbe usedtosupporttreatmentdecisions.

PatientCare Professionalism Systems BasedPractice Beabletodiscussthetreatmentoptionswiththepatientandmaketheappropriate consultations(medicaloncology,radiationoncology,dentistry,speechpathology, physicaltherapy,nutrition,andorsocial work)basedonthepatient’sneedsand wishes.Thiswillrequireconsiderationofthepatient’srightsandasensitivityto cultural,age,genderanddisabilityissues.

Administercareforthepost operativeoncologypatient.

Beabletodescribeprinciplesaboutandperforminterventionsforearlylaryngeal cancer.

Professionalism Practice BasedLearningand Improvement

Interpersonaland CommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletoperforminterventionsfor advanced laryngealcancer.

Goal2: Becompetentinevaluatingandmanagingotolaryngologypatients.

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Expandandrefineevaluationand managementskillsofotolaryngologypatients. SuchknowledgeshouldallowtheR4residenttoconfidentlyandindependentlycare forotolaryngologypatientsbytheendoftheyear.

Expandparticipationtoincludea leadershiproleinteachingconferencesfacilitating thelearningofthejuniorresidentsandmedicalstudents.

ExpandknowledgeofOtolaryngologyliteraturefor diseasesanddisordersofthe larynxandsleepsurgery.

Understandthelimitsofsurgicalandmedicaltreatment.

MedicalKnowledge PatientCare

Practice BasedLearningand Improvement

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Practice BasedLearningand Improvement

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge Recognizeandmanagesurgicalrisk factors. PatientCare MedicalKnowledge

Understandindicationsforurgentoperativedecisions,suchasaperformingasurgical airwayanddecompressinganexpandingneckhematoma

Administercareforthepost-operativepatient. PatientCare MedicalKnowledge

Expandthecapacitytorecognizeandtreatpost surgicalcomplicationseffectively, andlearntorecognizepreoperativeriskfactors.

Gainahealthyappreciationforthedangersinherentinmedicalintervention,and learnhowtobeappropriateinselectingpatientsforsurgery.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Practice BasedLearningand Improvement

Assumealeadershiproleinpostoperativecareofcomplicationssuchassalivary fistula,woundinfection,hematoma,cerebrospinalfluidleak,airwaycompromise, andhemorrhage.Teachthejuniorresidentsandmedicalstudentstomanagethese complications.

PatientCare

Practice-BasedLearningand Improvement

PatientCare Supervisepresentationofcomplicationsontheserviceatmonthly Morbidityand Mortalityconference.

Beabletosuccessfullytransitionfromsupervisionbyfacultytoprimarydecision makingwithfacultyoversight.

PatientCare Practice BasedLearningand Improvement

Demonstratecompetenceandorganizationalskills indirectingtheresidentteamin thedailymanagementofin housepatientsandORactivities.

Demonstrateabilityandcommitmentintheday to dayinformalteachingand mentoringofstudentsandjuniorresidents.

Beabletocompetentlysupervise/assistjunior residentsperformingcommon OTO/HNSsurgicalprocedures.

Beabletodemonstrateexcellentinterpersonalskills,effectivelysettingthetonefor othermembersoftheresidentteam,clinicalandnon clinicalstaff.

Practice-BasedLearningand Improvement

Practice BasedLearningand Improvement

Practice BasedLearningand Improvement

Professionalism

Goal3.Airway.Beabletoevaluateandformtreatmentplansforadultswithairwayobstructiondueupperairwayand tracheallesions.

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,and pathophysiologyofthelarynx. MedicalKnowledge

Beabletorecognize,describeandcategorizestridorinadults. Knowthemost commoncausesofstridoranddyspneainadults.

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

Beabletodiscussroutinecareofatracheostomyanddescribehowto recognize tracheostomyobstructionordecannulation.Beabletoeducateapatientaboutthe

PatientCare MedicalKnowledge

PatientCare

PatientCare MedicalKnowledge

risks/benefitsandcareofatracheostomy.Beknowledgeableabouthowtoobtainthe neededtracheostomyrelatedequipmentforpatientuseathome.

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

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

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

InterpersonalandCommunicationSkills Systems-BasedPractice

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare

Goal4.Videostroboscopy. Beabletoutilizeandtointerpretvideostroboscopyinthediagnosisoflaryngealdisorders.

ResidentObjectives: ACGMECompetencyGoals

Befamiliarwiththesetupandtechniqueofvideostroboscopy. PatientCare MedicalKnowledge

Understandthevariouscomponentsoflaryngealfunctionwhichcanbeassessedwith videostroboscopy(ie,vocalfoldwaveform,amplitude,glotticgap,etc).

Recognizethecharacteristicfeaturesofvariousdisordersasdiagnosedby videostroboscopy(ie,nodules,polyps,cysts,granulomas,spasmodicdysphonia).

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Goal5. SleepMedicine.Beabletoeffectivelyevaluateandtreatapatientwithasleeprelatedbreathingdisorder.

ResidentObjectives: ACGMECompetencyGoals

KnowtheindicationsforPAPtherapy,anddifferentmodalities includingCPAP,auto PAP,BiPAP,AutoBIPAP,AVAPS,andASV.

EvaluateandstimulatePAPcompliancethroughclinicalhistoryanddatadownloaded fromPAPmachine.

UnderstandandbeabletorecommendmethodstoimprovePAPcomplianceincluding maskrefitting,useofEPR,referraltobehavioraldesensitization.

Beabletointegratewithothermembersofasleepcenter,andknowhowto adequatelyreferpatientsformedical,dental,andbehavioralmanagementofsleep disorders.

PatientCare MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills

PatientCare InterpersonalandCommunicationSkills Systems BasedPractice

PatientCare Systems-BasedPractice

Beabletoanalyzedatafromthehistory,physical examination,sleeptest,nasal endoscopy,druginducedsleependoscopy,andimagingtestsandidentifywhowill benefitfromsomesortoftherapyandwhichtherapyshouldberecommended.

PatientCare MedicalKnowledge

Beabletoselectappropriatecandidatesfororaldevicetherapy. PatientCare MedicalKnowledge

Beabletoinformthepatientaboutweightloss,behavioralandpositional managementofSRBD.

Beabletoethicallyandthoroughlyprovideallavailabledatatopatientsandhelp him/hermake thebestpossibledecisiononsurgicalcareofOSA.

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

Understandtheindications,techniques,benefitsandrisksofsleepsurgeryinvolving thefacialskeleton(maxillomandibularadvancement,maxillary expansion/DOME, genioglossusadvancement). Performingcriticalpartsoftheprocedure.Incorporate virtualsurgicalplanning.

Understandtheinclusioncriteriaofhypoglossalnervestimulation.Performingcritical Partsoftheprocedure. Understandtheactivationprotocolafterimplantation.

Understandanddescriberisksand complicationsofOSAsurgery,includingvoiceand swallowingchanges,complexpainmanagement,facialparesthesias,infection,need forHGNSexplant,facialprofileandcosmeticchangesandneedforrevisionsurgery.Be abletoeffectivelyandcompassionatelycounselpatientsofthesedetails.

Effectivelyandcomprehensivelymanageprimaryinhouse,post-operativeandconsult patientswithobstructivesleepapneawith thejuniorandseniorresidents.

PatientCare InterpersonalandCommunicationSkills

PatientCare InterpersonalandCommunicationSkills Professionalism

PatientCare InterpersonalandCommunicationSkills Professionalism MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills Professionalism

PatientCare MedicalKnowledge Systems BasedPractice

Demonstrateappropriatesurgicaltechniqueforuvulopalatopharyngoplasty,beable toperformmostofthecervicalapproachinhypoglossalnervestimulationcases.Be abletoperformLefortosteotomiesduringmaxillomandibularadvancement

PatientCare MedicalKnowledge

Goal6.Improvecompetencyintheperformance of laryngology,sleep,andgeneralotolaryngology surgeries

ResidentObjectives: ACGMECompetencyGoals

Beadeptinperformingthefollowingprocedures:

· Diagnosticendoscopy

· Operativemicrolaryngoscopy

· Tracheotomy

· Salivarygland resections

· EndoscopicdilatationandCO2laserresectionforsubglotticstenosisand posteriorglotticstenosis

· Uvulopalatopharyngoplastyanditsmultiplemodifications

· Tonguesurgery volumereductionand/ortonguesuspension/suture

Becomeincreasinglyskilledin performingthefollowingprocedures:

· NeckDissection

· Laryngectomy(totalandpartial)

· Laryngopharyngectomy

· Parotidectomy

· Thyroidectomy

· Parathyroidectomy

· TypeIthyroplasty

· Arytenoidadduction

· Cricotrachealresection

· Trachealresection

· Maxillomandibularadvancement,maxillaryexpansion/DOME,genioglossus advancement

· Hypoglossalnervestimulator implant

PatientCare

PatientCare

Knowtheindications,perioperativecare,expectedoutcomesandpossible complicationsforallprocedureslistedabove.

PatientCare

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare

Goal6. Beabletotakecareofpatientsinanethical,efficientandcaringmannerwithinthecurrentmedicalsystem

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingand attendanceatradiologyrounds.

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,and outpatientvisits(CPTandICD 9).

Beabletoappropriatelydocumentpatientcareto supportcodinglevelsandto complywithinsurancepayorregulations(e.g.Medicare).

PatientCare

Systems BasedPractice

Professionalism

PatientCare InterpersonalandCommunicationSkills Systems BasedPractice Professionalism

Professionalism InterpersonalandCommunicationSkills Developanunderstandingofone’sownabilitiesandlimitationsincludingawareness ofsignsoffatigue.

Developanunderstandingofandsensitivitytotheimpactof cultural,economicand ethnicfactorsinthedoctor patientrelationshipandthedeliveryofhealthcare.

Professionalism Practice BasedLearningand Improvement

PrepareandguidejuniorresidentspresentationatweeklyHeadandNeckCase conference.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstrate theabilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraise clinicalstudies. Performliteraturesearchesasneededtocontinuouslyimprovethe levelofmedicalknowledge.

MedicalKnowledge Systems-BasedPractice

MedicalKnowledge Practice-BasedLearningand Improvement

RotationDirector: FredBaik,MD fbaik@stanford.edu

StanfordHealthCareScalpelService

GoalsandObjectivesPGY1:SHCScalpelService

ThePGY 1willparticipateinotolaryngologyroundsandunderthedirectionofthechief/seniorresidentwillberesponsibleforcare of inpatients.

Callduties:ThePGY1residentwilltakecallforin-housefloorpatientsfrom6:00amuntilafterroundsarecompleteandresidentsare releasedbythechiefresident.Onassignedweekends,theywilltakefloorcallduringtheday.PGY-1residentswillnottakeovernight call.

NOTE: Allresidents,includingthePGY1residents,willtakethein-trainingexamonthefirstSaturdayinMarch.

EvaluationandFeedback

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

Competency-basedGoalsandObjectives

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

ResidentObjectives: ACGMECompetencyGoals

•Knowtheimportantaspectsofhistoryandphysicalexaminationoftheotolaryngology patient.

PatientCare MedicalKnowledge

•Begintounderstandthediagnosisandtreatmentofcommonotolaryngologicdisorders. PatientCare MedicalKnowledge

•BecomefamiliarwiththeACGMEresidentcaselogsystem.

PatientCare MedicalKnowledge Systems BasedPractice

•Demonstrateself awarenessandtimemanagement/organizationalskills.

•PrepareandpresentattheweeklyHeadandNeckCaseconference

Goal2:Otolaryngology(“Scalpel”)Rotation: Tobegintodevelopotolaryngologysurgicalskills.

Practice BasedLearningandImprovement

MedicalKnowledge Systems BasedPractice

ResidentObjectives: ACGMECompetencyGoals

•Residentwillknowthenamesofcommonsurgicalinstruments. PatientCare

•Residentwilllearnbasicsuturingandknottyingtechniques.

•ResidentwillknowhowtosetuptheORforroutineotolaryngologycases.

•ResidentwilllearnthebasictechniquesofDirectlaryngoscopy,Esophagoscopy, Bronchoscopy.

•Residentwillgainexperiencebyassistingwithsurgical procedures.

•Residentwillbeintroducedtoflexiblelaryngoscopy.

Goal3:Otolaryngology(“Scalpel”)Rotation: Tobegintoorganizeaplanforaresearchprojectduringresidency.

ResidentObjectives: ACGMECompetencyGoals

•Meetwithatleastthreefacultymembersaboutpossibleresearchprojectsduringthe otolaryngologyresearchrotationinthePGY3year.

Professionalism

GoalsandObjectivesPGY2/3:SHCScalpelService

RotationContactsand SchedulingDetails

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Baik,Divi,Holsinger,Noel,Orloff,Sirjani, Sunwoo)

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow up. The teamshouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobeteachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

3. Communicationofsomesortisexpectedeachdaywith eachattending. Forsome,atextmessageisfine;forothers,aphone call. Atthestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

4. Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatient that theywillcheckwiththeattending.

5. Communicationwithfacultyregarding night-timecontactwithpatients Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcall theirchiefresidentto evaluate,whoshouldnotifythefellow,andthentheattending.TheR2shouldNOTbypassseniorresidents 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. Readaboutthecase. Knowthepatientandwhytheoperationis beingperformed,thelabs,etc.

10. Whenfacultyisoutoftown,continuetocommunicatewithattendingdailyifavailablebycellphone. Ifnot,then,communicate withthecoveringattendingorinstructor(designatedbytheattendingpriorto leaving).

11. TheresidentisrequiredtoattendtheThursdayH&Nteachingconference(H&Nteam). Atthisconference,thePGY 2willpresent acaseassignedbythechiefresidentandknowthetumorstageandbasicmanagementstrategies.

12. TheresidentwillalsoattendH&Ntumorboardinadditiontotheregularlyscheduledresidenteducationconferences.

EvaluationandFeedback

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

Competency-basedGoalsandObjectives

Goal1. Expandknowledgeinareaofheadandneckoncology.

ResidentObjectives:

ACGMECompetencyGoals

Beabletoaccuratelystagecancersoftheheadandneck. MedicalKnowledge

Developanunderstandingoftheroleofchemotherapyandradiationtherapyinthe treatmentofheadandneckcancer.

Begintobeabletoformulateatreatmentplanforheadandnecktumorswithsupervision, andbeabletoeffectivelycounselpatientsregardingtreatmentoptionsincludingrisks associatedwithsurgicaltreatment.

Progressinabilityto counselpatientsregardingheadandneckcancerriskfactors.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

Developanunderstandingoftheroleofsurgeryinthetreatmentof squamouscell carcinomaoftheheadandneck.

PatientCare MedicalKnowledge

Begintounderstandtheappropriatesurgicalproceduresforthetreatmentofheadandneck cancers. PatientCare MedicalKnowledge

Beabletowork upandtreatpatientswiththyroidandparathyroiddiseases. PatientCare MedicalKnowledge

Beabletowork upandtreatpatientswithmelanomaoftheheadandneck. PatientCare MedicalKnowledge

Beabletowork upandtreatpatientswithsalivarygland tumors.

Beabletorecognizethehistopathologicappearanceofcommonheadandneckneoplasms, includingparotidandthyroidpathology.

PatientCare MedicalKnowledge

MedicalKnowledge

Goal2. Consultsinanadulttertiarycarehospital. Learn aboutthemostcommonconsultsrequestedfromothermedicaland surgicalservicesregardinglaryngealproblemsinadults.

ResidentObjectives: ACGMECompetencyGoals

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandthe emergency department.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Professionalism Systems BasedPractice

Performinitialevaluationofallconsultpatients. PatientCare MedicalKnowledge

BefamiliarwiththeSCHelectronicmedicalrecord(EPIC)andbeabletoaccessinformation appropriately. Understandtheimportanceofconfidentialityinpatientmedicalrecords.

Evaluateconsultpatientswithseniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon clinicalstaffmembers.

PatientCare Professionalism Systems BasedPractice

PatientCare MedicalKnowledge Systems BasedPractice

InterpersonalandCommunicationSkills

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems. MedicalKnowledge Practice BasedLearningandImprovement

Createacompleteandcoherentconsultationnoteanddictateitina timelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

InterpersonalandCommunicationSkills Professionalism

Utilizetranslationservicestocommunicatewithnon Englishspeakingpatientsasneeded. InterpersonalandCommunicationSkills Systems BasedPractice

Demonstrateeffectivetime managementskills.

Practice BasedLearningandImprovement Professionalism

Follow uponconsultpatientsasneeded. PatientCare Systems BasedPractice Professionalism

PrepareandpresentattheweeklyHeadandNeckCaseconference. MedicalKnowledge Systems BasedPractice

Goal3.Expandabilitytoperform headandnecksurgicalprocedures

ResidentObjectives: ACGMECompetencyGoals

Beabletocompetentlyandefficientlyperformmid levelprocedureswithattending assistance PatientCare suchas:

• Directlaryngoscopyandbiopsy

• Flexibleandrigid esophagoscopy.

• Tonsillectomy

• Tracheostomy

• Panendoscopy

• Submandibularglandexcision

• Excisionofcongenitalcysts

• Resectionofsmallcarcinomas(e.g.tongue,floorofmouth)

• Resectionofmelanomaofthe headandneck

• Sentinellymphnodebiopsy

• Skingraftandflapreconstructionofheadandneckdefects

• Assistwithneckdissectionsandbegintounderstandtheanatomyandprinciples governingneckdissections

Goal4.Improvegeneralotolaryngologyknowledge

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthroughregular reviewofallpatientimagingandattendanceatradiology rounds.

PatientCare MedicalKnowledge

Learntoset-upandusethefacialnerveintegritymonitor. PatientCare Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD 9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomplywith insurancepayorregulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

PatientCare Systems BasedPractice

PatientCare Systems BasedPractice

Professionalism Systems-BasedPractice

Professionalism

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelofmedical knowledge.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

Professionalism Practice BasedLearningandImprovement

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

GoalsandObjectivesPGY4:SHCScalpelService

RotationContactsand SchedulingDetails

PleasecoordinateschedulesandcarewithAttendingSurgeonsfromHeadandNeckSurgery(Baik, Chen,Divi,Finegersh,Holsinger,Kaplan, Noel,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 eachattending. Forsome,atextmessageisfine;forothers,aphonecall. At thestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

4. Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatient thatthey willcheckwiththeattending.

5. Communicationwithfacultyregarding night-timecontactwithpatients

Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcalltheir chiefresidenttoevaluate,whoshouldnotify thefellow,andthentheattending.TheR2shouldNOTbypassseniorresidentsandgo directlytotheattending. Thisisforteachingpurposes.

6. Residentsareexpectedtomakeentriesintomedicalrecordsfornight timepatientcontacts.AnoteshouldbeenteredintoEpicfor eachcontactwithpatients.

7. Residentsshouldstrikeabalancebetweenlearningintheclinicandoperatingroom.However,thechiefresidentshouldanticipate andplaninadvancesothatclinicscanbecoveredasmuchaspossible. Thismayrequireaskingresidentsfromotherservicestohelp. ThereshouldneverbeachiefandtheR4goneatthesametime. ItmaybeadvisabletolimitvacationduringthemonthsofheavyR4 interviews.

8. Abriefoperativenoteshouldbeenteredwithinanhourofcompletionofthesurgerybytheresident.Dictationofoperativereports: within24hours.

9. PreparationforOR:Discusscasewithattendingthedaybefore. Readaboutthecase. Knowthepatientandwhytheoperationis beingperformed,thelabs,etc.

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

11. ResidentarerequiredtoattendtheThursdayH&Nteachingconference(H&Nteam)andtumorboardinadditiontotheregularly scheduledresidenteducationconferences.

EvaluationandFeedback

TheOHNSFacultyontheScalpelService(andselectedancillarymedicalpersonnel)will completewrittenevaluationsattheendofthe rotation. Selectedclinicpatientswillevaluatetheresidents. ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation. Dailyfeedbackonphysicalfindings,assessment,plan,andsurgical techniquewilloccurthroughclinicalinteractions.

Competency-basedGoalsandObjectives

Goal1.Expandknowledgeintheareaofhead&necksurgery,aswellasgeneralconceptsinsurgicaloncology

ResidentObjectives: ACGMECompetencyGoals

Beabletoidentifyclinicallysuspiciouslesionsoftheheadandneck,performappropriate biopsiesandimagingstudiestomakeadiagnosisinacosteffectiveandtimeefficient manner.

PatientCare MedicalKnowledge Systems BasedPractice Understandriskfactorsforheadandneckcancer,beabletoassesspatientsforriskfactors andbeabletocounselpatientsaboutmanagingtheriskfactors.

PatientCare MedicalKnowledge

Interpersonaland CommunicationSkills

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

Professionalism

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

Practice BasedLearningandImprovement InterpersonalandCommunicationSkills

Becomemorefamiliarwith ablativeandreconstructiveoptions.

Understandtheroleofadjuvanttherapy.

Beabletowork upandtreatpatientswiththyroidandparathyroiddiseases. Become familiarwiththeendocrinologyofthesedisordersandhowtodecidewhen interventionisappropriate.

Learnthefundamentalsofneckultrasound,toinclude optimizationofmachinesettings andaccurateidentificationofpathology.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge Systems BasedPractice Practice-BasedLearningandImprovement

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletowork-upandtreatpatientswithmelanomaoftheheadandneck. PatientCare MedicalKnowledge

Beabletowork upandtreatpatientswithsalivaryglandtumors. PatientCare MedicalKnowledge

PrepareandpresentattheweeklyHeadandNeckCaseconference.

MedicalKnowledge Systems-BasedPractice

Administercareforthepost-operativeoncologypatient. PatientCare MedicalKnowledge

Goal2.Improvecompetencyintheperformance ofheadandnecksurgeries

ResidentObjectives: ACGMECompetencyGoals

Beadeptinperformingthefollowingprocedures: PatientCare

· Diagnosticendoscopy

· Operativemicrolaryngoscopy

· Tracheotomy

· Oralcavitycancerresections

· Removalofskincancers

· Sentinellymphnodebiopsy

Becomeincreasinglyskilledinperformingthefollowingprocedures: PatientCare

·

NeckDissection

· Laryngectomy(totalandpartial)

· Laryngopharyngectomy

· Compositeresection

· Regionalflapsforreconstruction

· Maxillectomy

· Parotidectomy

· Thyroidectomy

· Parathyroidectomy

Knowtheindications,perioperativecare,expectedoutcomesandpossiblecomplications forallprocedureslistedabove.

PatientCare

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare Goal4. Beabletotakecareofpatientsinanethical,efficientandcaringmannerwithinthecurrentmedicalsystem

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewof allpatientimagingandattendanceatradiologyrounds.

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD 9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

PatientCare

Systems BasedPractice

Professionalism

PatientCare

InterpersonalandCommunicationSkills Systems BasedPractice

Professionalism

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Professionalism

InterpersonalandCommunicationSkills

Professionalism

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

Practice BasedLearningandImprovement

PrepareandguidejuniorresidentspresentationatweeklyHeadandNeckCaseconference. MedicalKnowledge Systems BasedPractice

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

MedicalKnowledge Practice BasedLearningandImprovement

RotationContactsand SchedulingDetails

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

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

RotationSpecifics

1. Roundingexpectations:teamistoroundtogetherinthemorningwiththechiefresidentleading. Allmembersoftheteamare expectedtoknowwhatisgoingonwitheachpatient. Ondischarge,patientsshouldhaveadateandtimeforfollow up. Theteam shouldestablishthispriortodischargebycallingtheclinicorcommunicatingwiththeP.A.Thechiefresidentisexpected tobe teachingthejuniorsonrounds.

2. Communicationwithfacultyregardingpatients afterrounds/weekends:

3. Communicationofsome sortisexpectedeachdaywith eachattending. Forsome,atextmessageisfine;forothers,aphonecall. At thestartoftheservice,thechiefshouldestablishthebestmodeofcommunicationwitheachattending.

4. Whentalkingwithpatients,residentsshouldavoidrelayingcareplansifthereisuncertainty. Theyshouldtellthepatientthatthey willcheckwiththeattending.

5. Communicationwithfacultyregarding night-timecontactwithpatients

Forseriousissues(e.g.shouldapatientgobacktotheOR),itisidealifcallsgoupthechainofcommand. R2soncallshouldcalltheir chiefresidenttoevaluate,whoshouldnotifythefellow,andthentheattending.TheR2shouldNOTbypassseniorresidentsandgo 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. TheresidentisrequiredtoattendtheThursdayH&Nteachingconference(H&Nteam). Atthisconference,thechiefresidentwill assignupcomingcasestojuniorresidents. He/shewillalsoparticipateinthisconferencebyansweringfacultyquestionsregarding

12. ResidentarerequiredtoattendtheThursdayH&Nteachingconference(H&Nteam)andtumorboardinadditiontotheregularly scheduledresidenteducationconferences.

13. Chiefresidentisexpectedtoattendthemonthlyfacultymeeting.

EvaluationandFeedback

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

Competency-basedGoalsandObjectives

Goal1: Becompetentinevaluatingandmanaginghead&neckotolaryngologypatients.

ResidentObjectives: ACGMECompetencyGoals

Expandandrefineevaluationandmanagementskillsof otolaryngologypatients.Such knowledgeshouldallowtheR5residenttoconfidentlyandindependentlycarefor otolaryngologypatientswithconditionsinvolvingheadandneckoncologybytheendof theyear.

Expandparticipationtoincludealeadershiproleinteachingconferencesfacilitatingthe learningofthejuniorresidentsandmedicalstudents.

ExpandknowledgeofOtolaryngologyliteraturefordiseasesanddisordersofthelarynx andcancersoftheheadandneck.

Beabletoidentifyclinicallysuspiciouslesionsoftheheadandneck, performappropriate biopsiesandimagingstudiestomaketomakeadiagnosisinacosteffectiveandtime efficientmanner.

MedicalKnowledge PatientCare

Practice-BasedLearningandImprovement InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge Practice BasedLearningandImprovement

PatientCare MedicalKnowledge Systems BasedPractice

Beabletoacquireappropriateinformationtostageheadandneck cancers,topresent casesintheHeadandNeckTumorBoardandtodeterminethebesttreatmentmodalityor modalities. WhenpresentingthecasesinTumorBoard,uptodateliteraturewillbeused tosupporttreatmentdecisions.Beabletodiscussthetreatmentoptionswiththepatient andmaketheappropriateconsultations(medicaloncology,radiationoncology,dentistry, speechpathology,physicaltherapy,nutritionand/orsocialwork)basedonthepatient wishes.Thiswillrequireconsiderationofthepatient’srightsandasensitivitytocultural, age,gender,anddisabilityissues.

Demonstratecompetencyinperformingcomprehensiveneckultrasoundtoassistin diagnosis,surgicalplanning,andimageguidedprocedures.Beabletorecognizecommon pathologies(thyroidnodules/cysts,malignancy,normalandabnormallymphnodes, parathyroidadenoma,ranula,thyroglossalductcyst).

Developacomprehensiveunderstandingofthecommonablativeandreconstructive options.

Understandthelimitsofsurgicaland medicaltreatment.

PatientCare MedicalKnowledge

Practice-BasedLearningandImprovement Systems-BasedPractice

InterpersonalandCommunicationSkills Professionalism

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Understandtheroleofadjuvanttherapy. PatientCare MedicalKnowledge

Understandindicationsforurgentoperativedecisions,suchasaperformingasurgical airwayanddecompressingan expandingneckhematoma

PatientCare MedicalKnowledge

Recognizeandmanagesurgicalrisk factors. PatientCare MedicalKnowledge Administercareforthepost operativeoncologypatient. PatientCare MedicalKnowledge

Expandthecapacitytorecognizeandtreatpost-surgicalcomplicationseffectively,and learntorecognizepreoperativeriskfactors.

Gainahealthyappreciationforthedangersinherentinmedicalintervention,andlearn howtobeappropriateinselectingpatientsforsurgery.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Practice BasedLearningandImprovement

Assumealeadershiproleinpostoperativecareofcomplicationssuchassalivaryfistula, woundinfection,hematoma, cerebrospinalfluidleak,airwaycompromise,and hemorrhage.Teachthejuniorresidentsandmedicalstudentstomanagethese complications.

Beabletoeffectivelyincorporateradiologicstudiesin assessingpatientswithheadand necktumorsinacosteffectiveandtimeefficientmanner.

Beabletosuccessfullytransitionfromsupervisionbyfacultytoprimarydecisionmaking withfacultyoversight.

SupervisepresentationofcomplicationsontheserviceatmonthlyMorbidityandMortality conference.

Demonstratecompetenceandorganizationalskills in directingtheresidentteaminthe dailymanagementofin housepatientsandORactivities.

Demonstrateabilityandcommitmentintheday to dayinformalteachingandmentoring ofstudentsandjuniorresidents.

Beabletocompetentlysupervise/assistjuniorresidentsperformingcommonOTO/HNS surgicalprocedures.

Beabletodemonstrateexcellentinterpersonalskills,effectivelysettingthetoneforother membersoftheresidentteam,clinicalandnon clinicalstaff.

Goal2: Beabletosafelyandefficientlyperformadvancedhead&neck surgicalskills.

PatientCare Practice BasedLearningandImprovement

PatientCare MedicalKnowledge Systems BasedPractice

PatientCare

PatientCare Practice BasedLearningandImprovement

Practice BasedLearningandImprovement

Practice BasedLearningandImprovement

Practice BasedLearningandImprovement

Professionalism

ResidentObjectives: ACGMECompetencyGoals

Refineoperativeskillsandgainexpertiseinadvancedsurgicalproceduresoftheheadand neck,aswellaslaryngology.TheR5Otolaryngologyresidentsareexpectedtoassumea graduatedresponsibilityinmorecomplexoperativecases.Throughtheirrotationthey shouldbecomecomfortablewithtakinganactiveroleinthetechnicalproceduressuchas:

• HeadandNeckSurgery

o NeckDissection

o Laryngectomy(totalandpartial)

o Laryngopharyngectomy

o Compositeresection

• EndocrineSurgery

PatientCare

o Thyroidectomy

o Parathyroidectomy

o Centralneckdissection

• ReconstructiveSurgery

o Regionalflapsforreconstruction

o Maxillectomy

o Anteriorskullbaseresection

o Parotidectomy

o Oralcavitycancerresections

o Melanomaoftheheadandneck

o Sentinellymphnodebiopsy

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD 9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicand ethnicfactorsinthedoctor patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’s ownabilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

PatientCare Systems BasedPractice

PatientCare Systems-BasedPractice

Professionalism Systems BasedPractice

Practice BasedLearningandImprovement

Practice BasedLearningandImprovement

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

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

LucilePackardChildren’sHospitalStanford GoalsandObjectives

WelcometothePediOHNSRotation!

RotationDirector: IramAhmad,MD,MME ahmadin@stanford.edu

Faculty:Ahmad,Balakrishnan,Chang,Cheng,Meister,Sidell,Truong,Valdez

RotationSpecifics:PleaserefertoPedsServiceGuidelinesprovidedbytheservice. GoalsandObjectivesPGY1: PEDIATRICOtolaryngology

Competency-basedGoalsandObjectives

Goal1. PediatricOtolaryngologyHospitalservice. Learnthecommonpediatricotolaryngologydisorderswhichrequirechildrento beinthehospital,thebasicsofhowtomanagethesepatients,andbasicsurgicalskills.

ResidentObjectives: ACGMECompetencyGoals Roundwiththepediatricotolaryngologyteam2timesadayandknowthecommon entitiesthatrequireachildtobehospitalized.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Systems BasedPractice

Learnthebasicsofhowtoperformflexiblelaryngoscopyonachild. Learnhowto operatetheMachineryonthescopecart.

BefamiliarwiththeLPCHelectronicmedicalrecord(EPIC)andbeabletoaccess informationappropriately. Understandtheimportanceofconfidentialityinpatient medicalrecords.

PatientCare Systems BasedPractice

PatientCare Professionalism Systems BasedPractice

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems. MedicalKnowledge

NOTE: Allresidents,includingthePGY1residents,willtakethe in-trainingexamonthefirstSaturdayinMarch.

Createacompleteandcoherentconsultationnoteanddictateitinatimelyfashion.This objectiveappliestoallpatientsseeninthehospitalsettingaswellastheoutpatient setting.

Utilizetranslationservicestocommunicatewithnon Englishspeakingpatientsas needed.

Practice-BasedLearningandImprovement

InterpersonalandCommunicationSkills Professionalism

InterpersonalandCommunicationSkills Professionalism Systems-BasedPractice

Demonstrateeffectivetime managementskills. Practice BasedLearningandImprovement

Begintoacquirethefollowingsurgicalskills: Suturingandknottyingtechniques. PatientCare Microscopesetup.

Cerumenremoval.

TonsillectomyandAdenoidectomysteps. Myringotomyandtubeplacementsteps.

PediatricOtolaryngologyClinics. Learnthecommonpediatricotolaryngologydisordersseeninpediatricotolaryngology clinicsandhowtoevaluatethesepatients.

Goal2.

ResidentObjectives: ACGMECompetencyGoals

Learnhowtoevaluateachildwithsleep-disorderedbreathing. PatientCare

Learnhowtoevaluateachildwithrecurrentearinfections. MedicalKnowledge Practicepneumaticotoscopy. InterpersonalandCommunicationSkills

Learnhowtoevaluateapediatricneckmass,particularlycongenitalneckmasses. PatientCare MedicalKnowledge

GoalsandObjectivesPGY2/3: PEDIATRICOtolaryngology

Competency-basedGoalsandObjectives

Goal1. Consultsinapediatrichospital. Learnaboutthemostcommonconsultsrequestedfromothermedicalandsurgicalservices regardingotolaryngologyproblemsinchildren.

ResidentObjectives: ACGMECompetencyGoals

BetheinitialcontactpersonforallconsultsfromotherLPCHservicesandtheemergency department.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Systems BasedPractice

Performinitialevaluationofallconsultpatients.

BefamiliarwiththeLPCHelectronicmedicalrecord(EPIC)andbeabletoaccess informationappropriately. Understandtheimportanceofconfidentialityin patient medicalrecords.

Evaluateconsultpatientswithseniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon clinicalstaffmembers.

PatientCare MedicalKnowledge

PatientCare Professionalism Systems-BasedPractice

PatientCare MedicalKnowledge Systems-BasedPractice

InterpersonalandCommunicationSkills Professionalism

Performaliteraturesearchtolearnmoreaboutunusual patientproblems.

Createacompleteandcoherentconsultationnoteanddictateitinatimelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellasthe outpatientsetting.

Utilizetranslationservicestocommunicatewithnon Englishspeakingpatientsas needed.

Demonstrateeffectivetime managementskills.

Follow uponconsultpatientsasneeded.

Attendatleastone“careconference”

MedicalKnowledge

Practice BasedLearningandImprovement

InterpersonalandCommunicationSkills Professionalism

InterpersonalandCommunicationSkills Systems BasedPractice Professionalism

Practice BasedLearningandImprovement

PatientCare Systems-BasedPractice Professionalism

Systems BasedPractice

Goal2. TonsillarandAdenoidalHypertrophy. Screen,diagnoseandmanagepatientswithsymptomssecondarytotheirtonsils and adenoids

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy, physiology,andpathophysiologyofthe tonsils/adenoids/eustachiantube.

MedicalKnowledge Takeasleephistorywithfocusedquestionsthatassistinthediagnosisofsleepapnea. PatientCare InterpersonalandCommunicationSkills

Describetheuse ofdiagnostictestsforassessingtonsilsandadenoids(e.g.airwayfilms, sleepstudies,nasalendoscopy).

Beableonphysicalexaminationtoassessobstructionbytonsils,adenoids,turbinates andnasalseptum.

PatientCare MedicalKnowledge

PatientCare

Describehowtoidentifyasubmucouscleftpalate. PatientCare

Beabletocounselparentsaboutthepathophysiologyofconditionsassociatedwith tonsillarandadenoidalhypertrophy,tonsillitisandadenoiditis.

PatientCare InterpersonalandCommunicationSkills

Understandtheindicationsfor tonsillectomyand/oradenoidectomyandalternative therapies. PatientCare MedicalKnowledge

Beabletocounselparentsabouttherisksandbenefitsoftonsillectomyand/or adenoidectomy.

Knowtheperioperativemanagementandexpectedpostoperativecourseofpatients whoundergotonsillectomyandadenoidectomy.

Beabletosafelyandefficientlyperformanadenoidectomyusingthefollowing techniques:microdebrider,coblation, curette.

Beabletosafelyandefficientlyperformatonsillectomyusingthefollowingtechniques: coldsnare,electrocautery,microdebrider,coblation.

Beabletodiscussthetreatmentofandprovidecaretopatientswithcomplicationsofa T&Aprocedure.

Goal3.Ears. Beableto evaluateandtreateardiseaseinchildren.

Professionalism InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare

PatientCare

PatientCare InterpersonalandCommunicationSkills

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyoftheearand eustachiantube.

Beabletotakeahistoryrelatedtotheearsandhearing.

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

Knowhowtoperformmicroscopicotoscopyandpneumaticotoscopy.

Understandtheavailabletreatmentsforacuteotitismediaandchronicserousotitis media.

Beabletodiscusstheindications,risks,benefits,andalternativestotympanostomy tubeplacement.

PatientCare

PatientCare MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills Beabletosafelyandefficientlyplacetympanostomytubes. PatientCare

Beabletocounselparentsabouttherisksandbenefitsoftympanostomytube placement.

Beabletodiscussandtreatcomplicationsfromtympanostomytubeplacement. PatientCare

Counselpatientsandfamiliesaboutpreventingnoiseexposureandhearinglossinthe wellchild/adolescentsetting(e.g.avoidingmusicandsoundsthatleadto high frequencyhearingloss,wearingearprotectorsfornoisytasks.)

Goal4.Airway. Beabletoevaluatechildrenwithbreathingproblems.

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills

ResidentObjectives: ACGMECompetencyGoals

Beabletoobtainanappropriateairwayhistory.

Beabletorecognize,describeandcategorizestridorinchildren.

Knowthemostcommoncausesofstridorinchildren.

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletoperformandinterpretflexiblelaryngoscopyinachild. PatientCare

Knowthemostcommoncauseofstridorandweakvoiceinachildwhohasundergone cardiacsurgery,andtheproceduresassociated.

Beabletoassembletheequipmentneededtoperformalaryngoscopy,bronchoscopy andesophagoscopy.

PatientCare MedicalKnowledge

PatientCare

Begintoknowhowtoperformadirectlaryngoscopyandbronchoscopyinachild. PatientCare

Discussroutinecareofatracheostomyanddescribehowtorecognizetracheostomy obstructionordecannulation.

PatientCare

Understandandbeabletodescribetoparentstherisksofatracheotomyinachild. PatientCare

Goal5. Nose. Diagnoseandmanagepediatricpatientswithnasalproblems.

Resident

MedicalKnowledge

InterpersonalandCommunicationSkills

Objectives: ACGMECompetencyGoals

Knowtheanatomy,physiology,andpathophysiologyofthenosein children.

Beabletoobtainahistoryrelatedtothenoseandnasalproblems.

Understandthesigns,symptomsanddifferencesbetweenchronicadenoiditisand sinusitisinchildren.

Understandtheetiology,presentation,diagnosisandtherapyofsinusitisinchildren withcysticfibrosis.

Understandandbeabletorecommendandinterpretancillarytests(e.g.plainfilms,CT scans)toevaluatenasalproblemsinchildren.

Beabletoevaluateaneonatewithnasalobstruction,andunderstandthe possible causesofneonatalnasalobstruction.

Beabletodescribeandrecognizecomplicationsofacutesinusitisinchildren.

MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Identifythesignsandsymptomsofallergicrhinitis. PatientCare MedicalKnowledge

Beabletodescribeandcomparepharmacologicoptionsfortreatmentofacuteand chronicadenoiditis,andsinusitis,andallergicandnonallergicrhinitis.

Goal

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Befamiliarwiththeprincipalmethodsforscreeningthehearingofanewborn (automatedauditorybrainstemresponse,Otoacousticemissions).

PatientCare MedicalKnowledge

Knowtheage appropriatewaytobehaviorallytestthehearingofinfantsandchildren. PatientCare MedicalKnowledge

Beabletointerpretroutine tympanogramsandaudiograms.

PatientCare MedicalKnowledge

6. PediatricAudiology. Understandthemethodsavailabletotestthehearinginchildren,andhowtointerpretthetests.

Describegeneralprinciplesaboutinterventionsforhearing-impairedchildren(speech training,signlanguage,amplificationdevices,communicationboards,cochlear implants).

Goal7.Neck. Beabletodiagnoseandtreatcommonproblemswhichoccurinthe neckinchildren.

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribethenaturalhistory,clinicalpresentation,evaluationand treatment optionsofneckabscesses(retropharyngeal,peritonsillar,parapharyngeal&lymph node)inchildren.

Knowthesymptoms,signs,andphysicalexaminationfindingsofathyroglossalductcyst andbranchialcleftcyst.

UnderstandthedifferentialdiagnosisofVascularanomaliesintheheadandneckin children,justasinfantilehemangiomas,lymphaticmalformations,andvenous malformations.

Goal8. GeneralPediatricOtolaryngology

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Beabletoobtainanappropriatehistoryregardingpossibleforeignbodyingestion.

Beabletodescribeandrecognizethesignsofsymptomsofear,nose,larynx,esophageal andbronchialforeignbodies.

Beabletodescribetherisksandbenefitsofforeignbodyremovalfromtheheadand neck.

Beabletodescribethesignsandsymptomsofankyloglossiaandtheindicationfor frenotomy.

Beabletocounselpatientsabouttheindications,risks, benefitsandalternativesto frenotomy.

Beabletosafelyandefficientlyperformafrenotomy.

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare Professionalism

Developanunderstandingofandsensitivitytotheimpactofcultural,economicand ethnicfactorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

Continuetoparticipateinthequalityimprovementprocessandtofollow up postoperativepatientswheneverpossible.

Systems-BasedPractice

Professionalism

Professionalism Practice BasedLearningandImprovement Systems-BasedPractice

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstrate theabilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraise clinicalstudies. Performliteraturesearchesasneededtocontinuouslyimprovethelevel ofmedicalknowledge.

DevelopanunderstandingofOHNScodingandcomplianceissuesinpediatric otolaryngology.

GoalsandObjectivesPGY4: PEDIATRIC

Competency-basedGoalsandObjectives

Professionalism Practice BasedLearningandImprovement

Professionalism Systems BasedPractice

Otolaryngology

Goal1. Beabletoprovideathoroughevaluationandcreateatreatmentplanforconsultandotolaryngologypatientsinapediatric hospital.

ResidentObjectives: ACGMECompetencyGoals

Willprovideback-uptotheR2residentforallinpatientandemergencyroomconsults.

IfR2residentisnotavailablewillbeinitialcontactpersonforallconsults. R4towork withtheR2inseeingtheconsultsandprovidingguidancereatreatmentplan. In conjunctionwiththeR2theR4willcommunicatewiththefellowandattending physicianretheconsult.

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism Systems BasedPractice

Willleadtwice-dailyroundsonallinpatientsontheotolaryngologyserviceandatleast once-dailyroundsonallconsultpatients. WillworktogetherwithpediatricOHNS fellowandattendingfacultytoprovideoptimumcare.

WillworktoeducatetheR2residentandmedicalstudentsrepatientproblems. (For example,discussingthedetailsofcarewiththemonmorningroundsandencouraging themtoreadaboutpertinentpatientissues.)

PatientCare

InterpersonalandCommunicationSkills Systems BasedPractice MedicalKnowledge

WillaidtheR2inperformingaliteraturesearchtolearnmoreaboutunusualpatient problems. MedicalKnowledge Practice BasedLearningandImprovement

Attendatleastone“careconference” Systems BasedPractice

Goal2. Beabletoevaluate pediatricpatientsintheclinicwithawiderangeofproblems.

ResidentObjectives: ACGMECompetencyGoals

Beabletotakeahistoryfrommorecomplicatedpediatricpatientssuchasthosewith multiplecongenitalanomaliesandmorecomplexotolaryngologyproblemssuchas thosewithairwayobstruction,tracheostomydependent,veloopharyngeal insufficiency,sensorineuralhearingloss.

Knowthefeaturesofcommonsequencesandsyndromesseeninpediatric otolaryngologypatientssuchas: Downsyndrome,velocardiofacialsyndrome, oculoauriculovertebralsyndrome,Treacher Collins syndrome,Crouzonsyndrome, PierreRobinsequence,Usher’ssyndrome,Pendredsyndrome.

Knowthecommongenetic abnormalitiesfoundinchildrenwithsensorineuralhearing loss.Knowhowtoorderthesetestsandinterpretthem.

MedicalKnowledge

MedicalKnowledge

MedicalKnowledge PatientCare Systems BasedPractice

Beadeptinperformingnasalendoscopyandflexiblelaryngoscopyin neonates. PatientCare MedicalKnowledge

Beabletoinitiateanevaluationofachildwithhypernasality. Understandthe importanceofcoordinatingcarewithaspeechpathologistknowledgeableabout velopharyngealinsufficiency.

PatientCare MedicalKnowledge Systems BasedPractice

Knowthesurgicalandnon-surgicaloptionsfortreatmentofvelopharyngeal insufficiency. BeabletoassistwithVPIproceduresandtounderstandtheperioperative course.

PatientCare MedicalKnowledge

Knowtheoptionsfortreatmentofdifferentvascularanomalies,includingsurgicaland medicalmanagementoptions. PatientCare MedicalKnowledge

Goal3. Ears. Beabletoevaluateandtreateardiseaseinchildren.

ResidentObjectives: ACGMECompetencyGoals

Knowthecommonpresentingsymptomsandfindingsinpediatricpatientswitha tympanicmembraneperforation,severeatelectasis,cholesteatoma,microtiaand sensorineuralhearingloss.

MedicalKnowledge PatientCare

Beabletoformulateappropriatetreatmentplansforallpatientswiththeaboveclinical conditions. PatientCare Interpersonaland CommunicationSkills

Knowtheindicationsforauralhabilitation(andrehabilitation)inchildrenwithhearing loss.Understandthetypesofhearingaidsavailableandthedifficultiesintreating childrenwiththesedevices.

MedicalKnowledge

Understandtheindicationsforbone anchoredhearingaidsandcochlearimplantsin children. PatientCare MedicalKnowledge

Beabletocounselfamiliesofchildrenwitheardiseaseregardingappropriatesurgical andnon surgicalmanagementoftheir child’scondition.

Beabletoperformanunderlaytympanoplasty,andsimpleMastoidectomy.Beableto assistwithcanalatresiareconstruction. Understandtheexpectedperioperativecourse andpotentialcomplicationsoftheseprocedures.

PatientCare InterpersonalandCommunicationSkills MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge Goal4. Beabletoevaluateandtreat childrenwithbreathingproblems.

Understandthetreatmentoptionsandtreatmenttimelineformicrotiaandcanal atresia.Beabletoassistinribcartilageharvestandauricularreconstruction.

ResidentObjectives: ACGMECompetencyGoals

Knowthecommoncausesandtreatmentsforchildrenwhopresentwithacomplaintof chronicthroatclearingand/orcough. Beabletocounselfamiliesregardingthese treatments.

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills

Beabletoformulateatreatmentrecommendationforchildrenwithairwayobstruction includingchildrenwithlaryngomalacia,subglotticstenosis,tracheal stenosis,laryngeal cleft,subglottichemangioma,subglotticcysts.

Knowtheindications,risksandbenefitsforthefollowingproceduresincluding; microdirectlaryngoscopywithexcisionoflesion,supraglottoplasty,laryngotracheal reconstruction,slidetracheoplasty. Beabletocounselpatientsregardingthese procedures.

Beabletodiscussthepost operativecare forthepatientwhohasundergonea Laryngotrachealreconstruction.

Knowthemostcommoncausesofacute onsetofstridorandhowtotreatthem (eg croup,supraglottitis,foreignbodyaspiration,deepneckabscess.)

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare

PatientCare MedicalKnowledge

Knowtheetiologyofperioperativelaryngospasminchildrenandhowtotreatit. PatientCare MedicalKnowledge

Knowtheetiology,typicalpatient,andtreatmentoptionsforvocalfolddysfunction syndrome(paradoxicalvocalfoldmotion).

Goal5. Diagnoseandmanagepediatricpatients withnasalproblems.

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Knowthepresentingsymptomsofachildwithchoanalatresia,nasaldermoid,nasal glioma,nasalencephalocele.

PatientCare MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills Understandthecausesofchronicsinusitisinchildrenandtheindicationsfor endoscopicsinussurgery.Beabletodiscusswithfamiliestheexpectedperioperative treatmentcourse. Beabletoperformendoscopicsunussurgeryunderdirect supervision.

Knowthedifferentoptionsforrepairofchoanalatresiaandunderstandtheindications, timing,risksandbenefitsofrepair.

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills Beabletosetupandutilizethesurgicalnavigation systemintheoperatingroom. PatientCare Systems BasedPractice

Goal6. Neck.Beabletodiagnoseandtreatcommonproblemswhichoccurintheneckinchildren.

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribethenaturalhistory,clinicalpresentation,evaluationandtreatment optionsofdifferenttypesofvascularmalformations.

PatientCare MedicalKnowledge

Knowthepresentation,work-up,andtreatmentforcongenital torticollis(fibromatosis colli)inyoungchildren.

PatientCare MedicalKnowledge

Beabletoformulateadifferentialdiagnosisforanytypeofneckmassinachild. PatientCare MedicalKnowledge

Goal7. GeneralPediatricOtolaryngology

ResidentObjectives:

Beabletoperformamicrodirectlaryngoscopy,andbronchoscopyinaneonate. Be abletoperformaroutinebronchoscopywithforeignbodyremoval,and esophagoscopywithforeignbodyremoval.

Continuetodevelopanunderstandingofandsensitivitytotheimpactofcultural, economicandethnicfactorsinthedoctor-patientrelationshipandthedeliveryof healthcare.

Continuetodevelopanunderstandingofone’sownabilitiesandlimitationsincluding awarenessofsignsoffatigue.

Continuetoparticipateinthequalityimprovementprocessandtofollow up postoperativepatientswheneverpossible.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstrate theabilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraise clinicalstudies. Performliteraturesearchesas neededtocontinuouslyimprovethe levelofmedicalknowledge.

ContinuetodevelopanunderstandingofOHNScodingandcomplianceissuesin pediatricotolaryngology.

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

ACGMECompetencyGoals

PatientCare

InterpersonalandCommunicationSkills

Professionalism Systems BasedPractice

Professionalism

Practice BasedLearningand Improvement Professionalism

Professionalism Practice-BasedLearningandImprovement

Professionalism Systems-BasedPractice

• DuringPGY2orPGY4’svacation/conference/interviewperiod,Half timeResearchResidentusuallyworksasfulltime.

Veteran’sAdministrationPaloAlto

RotationContactsand SchedulingDetails

RotationDirector: DavudSirjani,MD,dsirjani@stanford.edu,314 537 0242(cell)

AttendingswhoneedResidentcliniccoverage: Baik,Nayak,Sajjadi,Sirjani,Sung

PrivateAttendings-residentsdonotcover: Makarewycz

Fellows-donotneedResidentcliniccoverage: Facial Plastics KyleKimura

ImportantContacts:Main#650-493-5000(dial1→1→ ext#)

Administrators: ENTAdmin.email: v21palentadminpaloalto@va.gov

ErikNielsen:ext.63202,erik.nielsen1@va.gov

MariaTham:ext.66912,Maria.Tham@va.gov

SurgicalOnboardingTeam:vhapalsuronboarding@va.gov

ChargeNurse:EllaBenadam Lenrow:ext64047 Ella.Benadam Lenrow@va.gov

LVN:CrystalVo:ext64046 Crystal.Vo@va.gov

AdditionalRequiredConferences Clinicrules

Wednesday(everyotherweek)attheRadiologyConference Room(Building102)from8:30 9:30am

RNP:AnnieYuan:65203 Annie.Yuan@va.govAnnie.Yuan@va.gov

PA C:LeslieChan:ext.65535 Leslie.Chan@va.gov

Clinicstartspromptlyat9amand1pm

Pleasecompleteinpatientroundsandworkloadpriorto startofclinic

NON-OPERATIVEWEEK(starting7/1/21)

Time Monday-8:30am Tuesday-8:30am Wednesday-8:00am Thursday-7am Friday-7am

AM 08001200

MinorProc:PGY3>5 BaikClinic:PGY5>3,NP

FPclinic

PM 12001700

BaikClinic:PGY3,5,NP FPClinic

SirjaniClinic:PGY3,5, NP COCLIA (8:00 9:00am) NayakClinic(9:00): PGY3,5,PA

SirjaniClinic:PGY3,5, NP,R NayakClinic: PGY3,5,R,PA

**OR Sajjadi: PGY3or5

SungMinorProcedures: PGY3or5,PA

**OR Baik/Sirjani PGY3,5 RNPclinic(AY)

OR Sung PGY3or5

SajjadiClinic: PGY3or5,R,PA

Baik/Sirjani PGY3,5

Time Monday-8am Tuesday-8:30am Wednesday-7am Thursday-7am Friday-7am

AM 08001200

OR FP:PGY3,5 BaikClinic:NP

SirjaniClinic: PGY3,5,NP TumorBoard(8:30 9:30am)

OR Nayak:PGY3,5 0900SungClinic: R,PA

PM 12001700

OR FP:PGY3or5

BaikClinic: PGY3or5,NP

SirjaniClinic: PGY3,5,R,NP OR NayakPGY3,5

SungClinic: R,PA

**OR Sajjadi: PGY3or5 SungClinic/Minor Procedures:PGY3or5, PA

**2ORs Baik/Sirjani RNPclinic (AY)

OR SungPGY3of5

SajjadiClinic-JS,PGY3 or5,R,PA

**2ORs Baik/Sirjani **1residenttoscruboutforpre-opclinic

AdditionalNotes:

• MondayOPERATIVEWEEK:check-inpatientat8AM,casestartsat9AM

• Allother OPERATIVEWEEK:check inpatientinat7AM,casestartsat8AM

• ALLPATIENTS:SurgicalsiteMUSTbemarked,evenbilateralormidlinecasesneedawristbandstatingtheproceduretobedone.

RESEARCHRESIDENT(R:RESEARCHRESIDENT)

• Ifclinicneedsextra-helpfromResearchResidentpleasegivethosedatesinadvance.

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

• DuringPGY3orPGY5’svacation/conference/interviewperiod,Researchresidentusuallyworksasfulltime.

• ChecktoseeifhelpisneededforMondayproceduresinBaikclinictheweekbefore.

Non OperativeWeekWednesdays:COCLIA

• COCLIAistheComprehensiveOtolaryngologicCurriculumLearningthroughInteractiveApproachprovidedbytheAmericanAcademy ofOtolaryngology Head&NeckSurgeryFoundation.Itcanbefoundat: https://www.coclia.org.

• TheVAresidentsandallresidentsonfull timeor½ timeresearchwillparticipateinthebi weeklyCOCLIAsession.

• TheVAPGY5willpickatopicfromthecurriculumandassignquestionsfor eachresidentcover.

• Eachresidentwillprovideahandoutsummarizingtheanswerstotheirassignedquestions.

• ResearchresidentsmayparticipateviaZoomiftheyarenotscheduledtobeattheVAthatday.

RotationSpecifics

SeeAPPENDIX Q(VAPAHCSENTResidentHandbook)forcomprehensivedetails.

EvaluationandFeedback

TheVAPAHCSfacultyandselectedancillarymedicalpersonnelwillcompletewrittenevaluationsattheendoftherotation.Selected clinicpatientswillevaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation.Dailyfeedback onphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

GoalsandObjectivesPGY3: VAPA

Competency-basedGoalsandObjectives

Goal1. Expandknowledgeinareaofheadandneckoncology.

ResidentObjectives: ACGMECompetencyGoals

Beabletoaccuratelystagecancersoftheheadandneck.

MedicalKnowledge Developanunderstandingoftheroleofchemotherapyandradiationtherapyinthe treatmentofheadandneckcancer. MedicalKnowledge PatientCare

Begintobeabletoformulateatreatmentplanforheadandnecktumorswithsupervision, andbeabletoeffectivelycounselpatientsregardingtreatmentoptionsincludingrisks associatedwithsurgicaltreatment.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

Progressinabilityto counselpatientsregardingheadandneckcancerriskfactors. PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

Beabletowork upandtreatpatientswiththyroidandparathyroid diseases. MedicalKnowledge PatientCare

Beabletowork upandtreatpatientswithsalivaryglandtumors. MedicalKnowledge PatientCare

Beabletorecognizethehistopathologicappearanceofcommonheadandneck neoplasms,includingparotidand thyroidpathology.

Goal2. Expandknowledgeofcommonotologiccomplaints.

MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Beabletooutlinetheassessment,work up,andmanagementofsuddensensorineural hearingloss.

MedicalKnowledge PatientCare

Progressintheabilitytosystematicallyevaluatethedizzypatient. MedicalKnowledge PatientCare

Beabletoformulateoperativeandnon operativetreatmentplansforpatientswith chronicotitismedia.

MedicalKnowledge PatientCare PatientCare

Demonstratefacilitywithcounselingpatientsregardingtheexpectedrisksandbenefits associatedwithsurgeryforchroniceardisease.

Beabletodescribethepathophysiologyofcholesteatoma.

Developtheabilitytorecommend‘for’or‘against’hearingamplificationbasedon audiometricconsiderations,andbeabletoeffectivelyadvisepatientsregarding appropriateamplificationoptions.

Goal3.Expandknowledgeofcommonrhinologicdisorders.

MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

ResidentObjectives: ACGMECompetencyGoals

Progressintheabilitytoevaluateandtreatpatientswith epistaxis,includingnon operativeandoperativemanagementaswellascounselingpatientsregardingrisk reduction.

Beabletosuccessfullyevaluatepatientswithchronic sinusitis,andbeabletocounsel patientsregardingmedicalandsurgicaltreatmentoptions.

PatientCare MedicalKnowledge Practice-BasedLearningandImprovement

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice-BasedLearningandImprovement

Demonstrateincreasingfacilityanddiagnosticskillwithrigidnasalendoscopy.

Progressintheabilitytosuccessfullyinterpretsinusimagingstudies.

Beabletocompetentlycounselpatientsregardingtherisksassociatedwith sinonasal surgery.

PatientCare

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice-BasedLearningandImprovement

Goal4.Expandknowledgeofvoiceandswallowingdisorders

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyofthelarynx. MedicalKnowledge

Takeahistorywithfocusedquestionsthatassistinthediagnosisofhoarsenessand dysphagia.

Beabletosubjectivelyassessanddescribehoarseness(i.e.GRBASscale)

PatientCare

PatientCare MedicalKnowledge

Describetheuseofdiagnostictestsforassessinghoarseness(e.g.CTscans,laryngeal endoscopy,stroboscopy). PatientCare MedicalKnowledge

Beableonphysicalexaminationto assessdysfunctionofvocalfolds(i.e.paralysis). PatientCare

Beabletocounselparentsaboutthepathophysiologyofconditionsassociatedwithvocal foldparalysis.

Understandtheindicationsforvocalfoldmedialization(e.g.injection,thyroplasty, arytenoidrepositioning)andalternativetherapies.

Beabletocounselparentsabouttherisksandbenefitsofvocalfoldmedialization.

Beabletosafelyandefficientlyperformaflexiblefiberoptic nasolaryngoscopyand stroboscopy.

Befamiliarwiththeprincipallesionsthatcanaffectvocalfoldfunctionin adults(i.e. papilloma,polyp,nodule,cyst,cancer).

Beabletoidentifythevariousmethodsforlaryngealframeworksurgery(e.g.thyroplasty, arytenoidadduction);theirindicationsandtheirpossible complications.

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

PatientCare

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Professionalism

InterpersonalandCommunicationSkills

PatientCare

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Understandtheavailableradiographicandendoscopicmethodsof assessingswallowing. PatientCare

Goal5.Increaseknowledgeofsleepmedicine.

ResidentObjectives: ACGMECompetencyGoals

Increasecompetenceintheassessmentofpatientswithsuspectedsleepapnea.

Progressintheabilitytointerpretpolysomnographicdatainadults.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletoeffectivelycounselpatientsregardingtheconsequencesofuntreatedsleep apnea,andregardingappropriatetreatmentoptions.

PatientCare

MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

Goal6. Increaseknowledgeintheareaoffacialtraumaandreconstruction.

Resident

Objectives: ACGMECompetencyGoals

Beabletoperformathoroughphysicalexaminationinthefacialtraumaand reconstructionpatientwithacommandofpositivesignstobesoughtandtheir significance.

Beabletoeffectivelycounselfacialtraumaandreconstructionpatientsregarding treatmentoptions,potentialcomplications,andexpectedpost operativecourse.

Goal7.Expandknowledgeofheadandneckinfectiousdisorders.

Resident

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement

Objectives: ACGMECompetencyGoals

Beabletosuccessfullyevaluateandrecognizecasesofdeepneckinfection,andbeableto outlineanappropriatetreatmentplan.

Beabletodescribethepathophysiologyofnecrotizingfasciitis,andthetreatmentofthis disorder.

Demonstrateanunderstandingoftheclinicalpresentationofmycobacterialinfectionin theheadandneck,includingorganismsinvolvedandappropriatemanagement.

Beabletodescribethestagesoforbitalinfectionincomplicatedsinusitis,andoutline appropriatetreatmentoptions.

Goal8.Expandabilitytoperformsurgicalprocedures

ResidentObjectives:

Beabletocompetentlyandefficientlyperformmid levelprocedureswithattending assistancesuchas:

o Laryngology

Microlaryngealexcisionofpapillomas,polyps,leukoplakia Injectionlaryngoplasty

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

ACGMECompetencyGoals

PatientCare

o Otology/Neurotology

Tympanoplasty

Straightforwardsimplemastoidectomy

o HeadandNeck

Submandibularglandexcision

Excisionofcongenitalcysts

Resectionofsmallcarcinomas(e.g.tongue,floorofmouth)

Uvulopalatopharyngoplasty

o Rhinology

Septoplasty

Turbinatereduction

Selectedendoscopicsinussurgery(conchabullosa,polypectomy,partial ethmoidectomy,maxillary antrostomy)

o FacialPlasticandReconstructiveSurgery

Closednasalreduction

Opennasalreduction(straightforward)

Closureofcomplexfaciallacerations

Localflaps

Goal9.General knowledge

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds

PatientCare MedicalKnowledge

Gainanunderstandingoftheset upanduseoftheimage guidancesystem. PatientCare

Learntoset upandusethefacialnerveintegritymonitor. PatientCare

Demonstratecompetenceinthesafeandappropriateuseofvariouslasers. PatientCare

Learnthenuancesofcorrectlycodingsurgicalprocedures,consultations,andoutpatient visits(CPTandICD 9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g.Medicare).

PatientCare Systems BasedPractice

PatientCare Systems BasedPractice

Developanunderstandingofandsensitivitytotheimpactofcultural,economicand ethnicfactorsinthedoctor-patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodsto appraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

Professionalism

Systems BasedPractice

Professionalism

Professionalism

Practice-BasedLearningandImprovement

GoalsandObjectivesPGY5: VAPA

Competency-basedGoalsandObjectives

Goal1. Knowhowtocarefortheotolaryngologypatient.

ResidentObjectives: ACGMECompetencyGoals

TheR4/5willbeabletoefficientlyexecutetheevaluationofmostpatientswithoutmajor changesbeingsuggestedbysupervisingfaculty.

Demonstrateacommandofrelevantliteratureandbeabletoapplyitinthedevelopment ofanevaluationand(surgicaland/ornon surgical)treatmentplanforthefullspectrumof OTO/HNSproblemssuchas:

PatientCare MedicalKnowledge

o Headandneckmalignancy PatientCare MedicalKnowledge Practice BasedLearningandImprovement

o Complicatedsinonasaldisease PatientCare MedicalKnowledge Practice BasedLearningandImprovement

o Complexfacialreconstruction PatientCare MedicalKnowledge Practice-BasedLearningandImprovement

o Complexoto neurotologiccomplaints PatientCare MedicalKnowledge Practice BasedLearningandImprovement

o Advancedvoiceand swallowingdisorders PatientCare MedicalKnowledge Practice BasedLearningandImprovement

o Obstructivesleepapnea PatientCare MedicalKnowledge Practice BasedLearningandImprovement

Demonstrateconfidenceandcompetenceinthe managementofOTO/HNSemergencies.

PatientCare

Exhibitleadershipandclearthinkingwhileefficientlymobilizingappropriateresourcesto careforsuchproblemsasairwayemergencies,hemorrhage,andOTO/HNStrauma.

MedicalKnowledge

PatientCare MedicalKnowledge Systems BasedPractice

Demonstratetheabilitytothinkaheadandcontingencyplantoavoiderrorscausedbylack ofequipment,lackofstaff,orlackofappropriateattendingorspecialtyback up. Systems BasedPractice

Demonstrateproficiencyintherecognitionandmanagementofsurgicalriskfactors. PatientCare MedicalKnowledge

Demonstrateproficiencyintherecognition,management,andavoidanceofsurgical complications.

Beabletosuccessfullytransitionfromsupervisionbyfacultytoprimarydecisionmaking withfacultyoversight.

SupervisepresentationofcomplicationsontheserviceatmonthlyQualityAssurance conference.

Demonstratecompetenceandorganizationalskills indirectingtheresidentteaminthe dailymanagementofin-housepatientsandORactivities.

Demonstrateabilityand commitmentintheday-to-dayinformalteachingandmentoringof studentsandjuniorresidents.

Beabletocompetentlysupervise/assistjuniorresidentsperformingcommonOTO/HNS surgicalprocedures.

Beabletodemonstrateexcellentinterpersonalskills,effectivelysettingthetoneforother membersoftheresidentteam,clinicalandnon-clinicalstaff.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Practice-BasedLearningandImprovement

PatientCare MedicalKnowledge

Practice-BasedLearningandImprovement

Practice BasedLearningandImprovement

InterpersonalandCommunicationSkills

Goal2. Beabletoperformstandardotolaryngologyprocedures.

ResidentObjectives: ACGMECompetencyGoals

Beabletocompetentlyandefficientlyperformadvancedotolaryngologyproceduressuch as: PatientCare

o Otology/Neurotology

Tympanomastoidectomy

Ossicularchainreconstruction

Stapedotomy

o HeadandNeck

Maxillectomy

Partiallaryngealsurgery

Compositeresection

Totalparotidectomywithnervegrafting Surgicalmanagementofaggressivethyroid malignancy

o Rhinology

Revisionendoscopicsinussurgery

Orbitaldecompression

RepairofCSFleaks

o Laryngology

Microlaryngealexcisionofcancerwithlaser andcystswithmicroflaptechnique

EndoscopicandopencricopharyngeausandZenker’sdiverticulumsurgery

Thyroplastyandarytenoidrepositioningsurgery

Inofficeinjectionlarygoplasty,lasersurgery,andtrans-nasalesophagoscopy

o General

Advancedtechniquesinobstructivesleepapneasurgery

o FacialPlasticandReconstructiveSurgery

Complexfacialtrauma,suchasLeFortfractures,naso orbital ethmoidfractures, andcomminutedmandibleandmidfacefractures

Functionalrhinoplasty

Repairofpost traumaticandpost ablativedefects

Skinresurfacingformalignancyprophylaxis

Goal3. Haveacomprehensiveotolaryngologyknowledgebase.

ResidentObjectives: ACGMECompetencyGoals

Developcompetenceintheinterpretationofheadandneckimagingstudiesthrough regularreviewofallpatientimagingandattendanceatradiologyrounds.

Learnthenuancesofcorrectlycoding surgicalprocedures,consultations,andoutpatient visits(CPTandICD-9).

Beabletoappropriatelydocumentpatientcaretosupportcodinglevelsandtocomply withinsurancepayorregulations(e.g. Medicare).

Developanunderstandingofandsensitivitytotheimpactofcultural,economicandethnic factorsinthedoctor patientrelationshipandthedeliveryofhealthcare.

Developanunderstandingofone’sown abilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

PatientCare MedicalKnowledge

PatientCare Systems BasedPractice

PatientCare Systems BasedPractice

Professionalism Systems BasedPractice

Professionalism

Professionalism Practice-BasedLearningandImprovement

StanfordHealthCare: SpecialtiesTeam(Scope)

RotationContactsand SchedulingDetails

RotationDirectors: Otology/Neurology Rhinology

FacialPlastics NikolasBlevins,M.D. PeterHwang,MD SamMost,MD nblevins@stanford.edu hwangph@stanford.edu smost@stanford.edu

Attendings:Alyono,Blevins,Hwang,Jackler,Most,Nayak,Patel,Pepper,SantaMaria, Stankovic,Steenerson

WeeklySchedule

Monday Tuesday Wednesday Thursday Friday

AM

BlevinsOR MostOR Hwangclinic PepperOR(1st/3rd Mondays) Alyonoclinic Steenersonclinic

HwangOR StankovicOR Mostclinic Jacklerclinic Capassoclinic(RWC) Alyonoclinic SantaMariaclinic Steenersonclinic

MostMRP JacklerOR Blevinsclinic Hwangclinic Pepperclinic Alyonoclinic

BlevinsOR HwangOR SantaMariaOR Nayakclinic Stankovicclinic Steenersonclinic FPfellowclinic

AlyonoOR MostOR NayakOR PepperOR Allergyclinic Blevinsclinic Steenersonclinic

PM

BlevinsOR MostOR Hwangclinic PepperOR(1st/3rd Mondays) Alyonoclinic Steenersonclinic

HwangOR StankovicOR Jacklerclinic Capassoclinic(RWC) Mostclinic Alyonoclinic SantaMariaclinic Steenersonclinic

MostMRP JacklerOR Blevinsclinic Hwangclinic Pepperclinic Alyonoclinic

BlevinsOR HwangOR SantaMariaOR Nayakclinic Mostclinic Stankovicclinic Steenersonclinic

AlyonoOR MostOR NayakOR PepperOR Blevinsclinic Steenersonclinic Rhinologyfellow clinic JaneWangclinic

NOTE:

Everyresidentisexpectedtoattend:

o 1CochlearImplantconferenceeachrotation(7:30 8:30amthe2nd and4th Wednesdaysofthemonth). https://stanford.zoom.us/j/389328364?pwd=WXg4WEJMMll4Y0xmbjh5VHVrNEpWZz09

o 1StanfordBalanceCenterconferenceeachrotation(7am 8am),typicallythe3rd Tuesdayofthemonth.

https://stanford.zoom.us/j/4043246859?pwd=YzZFN3RTNzBLMEIxNXhvMHlOSEVLUT09&from=addon

RotationSpecifics

1. Theteamisexpectedtoroundtogetheronallpatients. “Splitting”theteamtocoverroundsondifferentpatientsisnot acceptable.Roundsshouldoccurtwotimesdaily.

2. Duringtheweekaresidentshouldhaveaconversationwitheachattendingrehis/herpatients. Ontheweekendsomekindof formalnotification(phone,text,etc)isexpecteddaily.

3. Allphonecalls/patientcontactsshouldbeenteredintoEPIC. Contactattendingdirectlyifneeded.

4. TheR2residentistheinitialcontactpersonforallconsults. Allconsultsshouldbeseenbyanattending-presentedthesameday andsignedoffbythenextday. Discusstheconsultlistonroundsdaily.

5. Thereshouldbeacultureofteachingatalllevels.

6. ChiefscanassignappropriatecoverageofOR’s. WhenORiscompleteresidentsshouldgotoclinic. “Keyindicatorcases”should takeprecedence.Residentsshouldseepost opcasesintheclinicwheneverpossible.

7. Residentsneedtogotoschedulededucationalsessionsandshouldbreakoutofcasesasneeded. Ontimeattendanceisexpected exceptforemergencies.

8. Residentsareexpectedtoreadaboutcasesinadvanceandcheckonimportantclinicalinfo(CT,MRI,Audio,Pathetc).

9. Whenfacultyareoutoftownresidentsshouldextendcoveragetootherclinics/OR’swhichareusuallyuncovered. Chiefscan makeassignmentforotherwiseunassignedtime.

EvaluationandFeedback

Thefaculty,andselectedancillarymedicalpersonnelwillcompletewrittenevaluationsattheendoftherotation. Selected clinicpatients willevaluatetheresidents. ResidentswillbeaskedtoevaluateeachFacultyMemberandtherotation.Dailyfeedbackonphysicalfindings, assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

GoalsandObjectivesPGY1: SHCSpecialtyService

Competency-basedGoalsandObjectives

Goal1.OHNSspecialtyserviceinpatients. Learnaboutthemostcommonsurgeriesanddisordersrequiringadmissiontothehospital.

ResidentObjectives: ACGMECompetencyGoals

Roundwiththeinpatientteam2xdaily. LearnthemostcommonsurgeriesandOHNS disordersrequiringadmissiontothehospital.Understandtheexpectedhospitalcourse andrequirementsfordischarge.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Professionalism Systems BasedPractice

BecomefamiliarwiththeStanfordEMR(EPIC)andhowtoinputorders.

PatientCare MedicalKnowledge Systems BasedPractice

Begintodevelopsurgicalskillsinthefollowingareas:

FacialPlasticsservice: suturing/softtissuehandling,squireknot tying,patient positioning,identifyofcommonsurgicalinstrumentsandhandlingtechniques.

Sinus/rhinology: Inferiorturbinatereduction,zero degreerigidnasalendoscopy,office balloonsinuplasty,officepolypectomy,allergyclinic(shotskillsandinterpretations at least6visits)

Otology: in clinicbinocularmicroscopy,cerumenremoval,mastoidbowlcleaning,basic audiologictestingandinterpretations.

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems.

PatientCare

MedicalKnowledge

Createacompleteandcoherentconsultationnoteand dictateitinatimelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

Utilizetranslationservicestocommunicatewith non Englishspeakingpatientsasneeded.

MedicalKnowledge

Practice BasedLearningandImprovement

InterpersonalandCommunicationSkills Professionalism

InterpersonalandCommunicationSkills Systems BasedPractice

Demonstrateeffectivetime managementskills.

Practice BasedLearningandImprovement

GoalsandObjectivesPGY2/3: SHCSpecialtyService

Competency-basedGoalsandObjectives

Goal1.Consultsinanadulthospital. Learnaboutthemostcommonconsultsrequestedfromothermedicalandsurgicalservices regardingotolaryngologyproblems.

ResidentObjectives: ACGMECompetencyGoals

BetheinitialcontactpersonforallconsultsfromotherSHCservicesandtheemergency department.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism Systems BasedPractice

Performinitialevaluationofall consultpatients.

Evaluateconsultpatientswithseniorresidentorfellowandfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwith clinicalandnon clinicalstaffmembers.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge Systems BasedPractice

InterpersonalandCommunicationSkills

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems. MedicalKnowledge

Practice BasedLearningandImprovement

Createacompleteandcoherentconsultationnoteanddictateitinatimelyfashion.This objectiveappliestoallpatientsseenintheclinicsettingaswellastheoutpatientsetting.

Utilizetranslationservicestocommunicatewithnon Englishspeakingpatientsasneeded.

InterpersonalandCommunicationSkills

Professionalism

InterpersonalandCommunicationSkills

Systems BasedPractice

Demonstrateeffectivetime managementskills.

Follow-uponconsultpatientsasneeded.

Goal2. Nasalcavityandsinuses. Diagnoseandmanagepatientswithnasalproblems.

Practice BasedLearningandImprovement

PatientCare Systems BasedPractice Professionalism

ResidentObjectives: ACGMECompetencyGoals

BefamiliarwiththeEMRatStanford(EPIC)toconfidentiallyaccessappropriatepatient information,pastcultureresults,pathologyreportsandpastimagingstudies.

Evaluateconsultpatientswithsinonasaldisorderswiththeseniorresidentsandfaculty. Beabletodocumentandcommunicaterecommendationsandplanwiththeprimaryteam inaprofessionalandcourteousmanner.

PatientCare Professionalism Systems BasedPractice

PatientCare MedicalKnowledge Systems BasedPractice

InterpersonalandCommunicationSkills

Knowtheanatomy,pathophysiology,anddevelopmentofthenasalcavityandsinuses. MedicalKnowledge

Performliteraturesearchestoinvestigatecommonandrare patientpresentations,andto obtainevidenceforcurrentpracticeparadigmsinpatientcare.

UnderstandprinciplesandutilityofCTversusMRIimagingofthesinuses. Understandand describeanatomicvariationsofthe4pairsofparanasalsinuses,patternsofuncinate processattachmentandsinusdrainagepatterns.

Beabletoobtainadetailedhistory relatedtothenoseandnasalproblemsrelatedtosinus diseaseandallergicrhinitis.

Performsafe,informativeroutineofficenasalendoscopywith0degreeand30degreerigid endoscopes.

AccessandunderstandAAOdescriptiveguidelinesforacute,subacuteandchronic sinusitis,andknowthemajorandminorsymptomsassociatedwithdiagnosisofsinusitis.

MedicalKnowledge Practice-BasedLearningandImprovement Professionalism

MedicalKnowledge InterpersonalandCommunicationSkills

PatientCare InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge Systems BasedPractice

Evaluatepatientswithchronicsinusitiswithandwithoutpolyposis anddistinguish whichpatientsmayrequiresurgeryormedicaltherapy.

Beabletodescribeandrecognizecomplicationsofacutesinusitis.

Identifythesignsandsymptomsanddifferencesbetweenallergicrhinitisand acute/chronicsinusitis.

PatientCare MedicalKnowledge Professionalism

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Understandindicationsforsafe intranasalofficebiopsy. PatientCare MedicalKnowledge

Beproficientwiththeevaluationandmanagementalgorithmsfortreatingepistaxis. PatientCare MedicalKnowledge

Understandoptionsfortreatmentofnasalseptaldeviationand turbinatehypertrophy. PatientCare MedicalKnowledge

Learntheassemblyofequipmentneededtoperformnasalendoscopy,andintraoperative imageguidance.

Completebasicaspectsofendoscopicapproachestothenasalcavity includinguseof zero degreeand30degree endoscopes,safelynavigatingthenasalcavitywithmucosal preservingtechnique,performingseptoplasty,turbinatereduction,maxillaryantrostomy, andanteriorethmoidectomy.

Goal3. Allergy–ContactDr.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

atleastonemonthpriortoyourvisit.

ResidentObjectives: ACGMECompetencyGoals

Properhistory/evaluationandassessmentoftheallergypatient

Knowledgeoftherapiesforthegeneralallergypatient,includingmedicationclasses, dosages,sideeffects,andcombinationtherapies

Properadministrationofaskin pricktestx1

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare

MengChen(mengchen@stanford.edu)

Properinterpretationofaskinpricktest,andhistoricendpointtitrationtest interpretation

Properdesignofanimmunotherapystrategybasedonpricktesting(Eachresidentwill receiveinstructioninimmunotherapydesign fromtheallergyteam).

MedicalKnowledge

MedicalKnowledge PatientCare

Understandingthegoals,principlesandpracticeofASAdesensitizationtherapy,andhow AERD/ASAintolerancediffersfromclassicallergicreactions. MedicalKnowledge Advantages/disadvantages/principlesofintradermalvs.sublingualimmunotherapy MedicalKnowledge

Goal4.Understandthebasicsoftheaestheticpatientconsultation

ResidentObjectives: ACGMECompetencyGoals

Performinitialcontactwithoutpatientfacialplasticspatientconsultation. PatientCare

Understandpathophysiologyofagingprocess. MedicalKnowledge

Goal5.Understandtheapproachtotherhinoplastypatient

ResidentObjectives: ACGMECompetencyGoals

Performinitialcontactwithoutpatientconsultationfornasalobstructionand/oraesthetic rhinoplasty. PatientCare

Understandpathophysiologyofnasalobstruction. MedicalKnowledge

Goal6.Understandtheapproachtothefacial traumapatient

ResidentObjectives: ACGMECompetencyGoals

Provideeffectivespecialistconsultservicestotraumateam/EDforfacialtrauma. PatientCare

MedicalKnowledge

Professionalism

InterpersonalandCommunicationSkills

Understandwoundhealing. MedicalKnowledge Understandconceptsofocclusion. MedicalKnowledge

Evaluatepatientswithfacialparalysis. PatientCare MedicalKnowledge

Understandpathophysiologyoffacialparalysis. MedicalKnowledge

Goal7.ChronicOtitisMedia.Screen,diagnoseandmanagepatientswithsymptomssecondarytotheirchronicearinfections

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyofthemiddleear and mastoid.

MedicalKnowledge

Takeadirectedhistoryfocusedonissuesrelatedtorecurrentandchronicearinfections. PatientCare

Describetheuseofdiagnostictestsforassessingotologicdisease(e.g.CTandMRI imaging,audiology,tympanometry).

PatientCare MedicalKnowledge

Beabletoassesstheexternalandmiddleearonexam,includingtheuseofthebinocular microscope. PatientCare

Differentiatemiddleearfromexternaleardisease PatientCare

Beabletocounselparentsaboutthepathophysiologyofconditionsassociatedwith chronicotitis,itsrisks,andtreatmentoptions. PatientCare InterpersonalandCommunicationSkills Understandtheindicationsforsurgicalintervention,itsrisksandpotential complications PatientCare MedicalKnowledge

Beabletocounselparentsabouttherisksandbenefitsoftympanomastoidsurgery. Professionalism

InterpersonalandCommunicationSkills

Knowtheperioperativemanagementandexpectedpostoperativecourseofpatientswho undergotympanomastoidsurgery.

Beabletosafelyandefficientlyperformtheapproachfortympanomastoidsurgery (postauricularincisions,canalincisions,harvestinggraftmaterials).

PatientCare

PatientCare

Becomfortablewithmastoidectomytechniques(bonylandmarks,useofdrillforcortical boneremoval,effectiveuseSuction-irrigationsystem).

Beabletodiscussthebasicsoftympanomastoidsurgerypatientsincludingpotential complicationsandpostoperative expectations.

Goal8.Vertigo. Beabletoevaluateandtreatperipheralvestibulardisease.

ResidentObjectives:

Beabletodescribetheanatomy,physiology,and pathophysiologyoftheperipheral vestibularsystem.

Beabletotakeahistoryrelatedtobalanceandvertigo.

PatientCare

PatientCare InterpersonalandCommunicationSkills

ACGMECompetencyGoals

MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare Understandtreatmentsavailableforacutevestibulardysfunctionintheclinicand emergencyroom.

Knowhowtoperformclinicalexaminationofpatientswith vestibularcomplaints.

PatientCare MedicalKnowledge

Beabletodiscussfactorsinvolvedinvertigoandbalancedysfunctionwith patientsand families.

Beabletocounselparentsaboutthevarioustreatmentoptionsavailableformanagement ofMeniere’sdisease,paroxysmalpositioningvertigo,and vestibularneuronitis,superior semicircularcanaldehiscence,etc

Beabletointerpretthebasicsofvestibularfunctiontests.

Beabletodiscusscareof vertigopatientswithprovidersfromotherspecialtiesto formulateacareplaninvolvinganumberofdisciplines.

Counselpatientsandfamiliesaboutcompensatorystrategiesforminimizingrisksin chronicvestibulopathyincludingtheroleofvestibularrehabilitationandphysicaltherapy.

Goal9.HearingLoss

PatientCare

InterpersonalandCommunicationSkills MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

ResidentObjectives: ACGMECompetencyGoals

Beabletoobtainanappropriatehearinglosshistory.

PatientCare

Beabletorecognize,describeandcategorizeacquiredandcongenitalhearingloss. PatientCare MedicalKnowledge

Knowthemostcommoncausesofsensorineuralvsconductivehearingloss. PatientCare MedicalKnowledge

Beabletoperformandinterpretappropriatephysicalexaminationforhearingloss, includingtuningforkexam,otomicroscopy,cranialnerveexam,pneumo otoscopy.

PatientCare Understandthebasicsofaudiometry,andhowtointerpretcommonaudiometrictests. PatientCare MedicalKnowledge

Beabletocounselpatientsabouthearingaidsandassistivelisteningdevices.

Understandthebasicoptionsinvolvedinthesurgicalcorrectionofconductivehearing loss(stapedectomy,ossiculoplasty).

PatientCare MedicalKnowledge

PatientCare

PatientCare Beabletodiscussthebasicsofcochlearimplantationwithpatientsandfamilies,including thebasicsofsurgery,postoperativeexpectations,andneedforrehabilitationservices.

Gainbasiccapacityforevaluatingossicularchainmobilityintraoperatively,andgaina foundationforbimanualmanipulationofprosthesesunderthesurgicalmicroscope.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Goal10. Neurotology. Diagnoseandmanagepatientswithskullbasedisease

ResidentObjectives: ACGMECompetencyGoals

Knowthebasicanatomy,physiology,andpathophysiologyoftheskullbase.

Beabletoobtainahistoryrelatedtoextra axialneoplasmsandotherlesionsofthe internalauditorycanal,cerebello-pontineangle,temporalboneandposteriorfossa.

Understandthebasicanatomy,signs,symptomsandclinicaldiagnosisoflesionsofthe petrousapex.

MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Understandthebasicsofradiologicstudiesusedtodiagnoselesionsoftheposterolateral skullbase.

Understandtheindicationsofancillarytests(e.g.angiography,electrodiagnosticstudies) toevaluateskullbaselesions.

Beabletoevaluateapatientwithvestibularschwannomaintheclinic, includinghistory, physicalexamination,audiometricdata,andradiologicstudies.

Beabletodescribeandrecognizecomplicationsofcranialbasesurgery.

Beabletocollaboratewithamultidisciplinaryteamtoprovidecomprehensivecarefor patientswithskullbaselesions.

Understandthebasicmanagementoptionsforbenignlesionsofthe posterio lateralskull baseincludingwatchfulwaiting,focusedradiation,andmicrosurgicalresection.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Goal11.Audiology. Understandthemethodsavailabletotestthehearing,andhowtointerpret thetests.

ResidentObjectives: ACGMEcompetencygoals

Befamiliarwiththeprincipalmethodsandindicationsforvariousaudiometrictests includingpure-tonetesting,wordrecognitionsscores,reflextesting,tympanometry).

Befamiliarwiththebasicsofassessingreliabilityinaudiometrictesting.

Beabletointerpretroutinetympanogramsandaudiograms.

Understandthebasicsofmostspecializedelectrodiagnosticstudiesandtheirindications (includingABR,ECOG,VEMP,rotationalchair,posturographytesting,VNG,etc).

Goal12.Facialnerve. Beabletodiagnoseandtreatcommonfacialnerveproblems.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

ResidentObjectives: ACGMEcompetencygoals

Beabletodescribethebasicanatomyofthefacialnerveanditscommondisorders, includingtheirnaturalhistory, clinicalpresentation,evaluationandtreatment.

Understandthemanagementofacutefacialparalysis,especiallyasitappliestothe postoperativepatient.

Goal13. General Otology

ResidentObjectives

Beabletoobtainanappropriatehistoryregardingexternaleardisease,includingacute andchronicotitisexternaandcerumenimpaction.

Becomecomfortablewithotoscopicexaminationandproceduresinvolvingtheexternal auditorycanalincludingcanaldebridementandcerumenremoval.

Beabletodiscusstheprocedure,risks,benefits,and expectationsofmyringotomywith aspiration,andmyringotomywithtubeplacement.

Beabletodiscussthebasicsoftinnitusdiagnosisandmanagement.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

ACGMEcompetencygoals

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Beabletoperformadirectedhistoryandphysicalexaminationforpatientswithotalgia. PatientCare MedicalKnowledge

Knowhowtoobtainconsultationfromotherrelatedservicesforpatientswithotologic disorders.

Developanunderstandingofandsensitivitytotheimpactofcultural,economicand ethnicfactorsinthedoctor patientrelationshipandthedeliveryofotologiccare.

Developanunderstandingofone’sownabilitiesandlimitationsincludingawarenessof signsoffatigue.

Becomeanintelligentuseroftheacademicliteratureinotolaryngology. Demonstratethe abilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

PatientCare InterpersonalandCommunicationSkills

Professionalism Systems Based Practice

Professionalism

Professionalism

Practice-BasedLearningandImprovement

Professionalism

DevelopanunderstandingofOHNScodingandcomplianceissuesinotology/ neurotology.

Systems BasedPractice

GoalsandObjectivesPGY4: SHCSpecialtyService

Competency-basedGoalsandObjectives

Goal1. Consultsinanadulthospital. Continuetolearnaboutconsultsrequestedregardingotologicproblems.

ResidentObjectives: ACGMECompetencyGoals

BethebackuporinitialcontactpersonforconsultsfromotherSHCservicesandthe emergencydepartment.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Professionalism Systems BasedPractice

Performinitialorbackupevaluationforconsultpatients. PatientCare MedicalKnowledge

BefamiliarwiththesubtletiesoftheSHCelectronicmedicalrecord(Epic)andbeableto accessinformationappropriately. Understandtheimportanceofconfidentialityinpatient medicalrecords.

Evaluateconsultpatientswithchiefresident,fellow,andfacultymemberand communicaterecommendationsandplantoprimaryteam.Consistentlydemonstrate courtesywheninteractingwithclinicalandnon clinicalstaffmembers.

PatientCare Professionalism Systems BasedPractice

PatientCare MedicalKnowledge Systems BasedPractice InterpersonalandCommunicationSkills

Performaliteraturesearchtolearnmoreaboutunusualpatientproblems,andteachother residents,andmedicalstudents. MedicalKnowledge Practice BasedLearningand Improvement

Createorreviewacompleteandcoherentconsultationnoteanddictateitinatimely fashion.Thisobjectiveappliestoallpatientsseenintheclinicsettingaswellasthe outpatientsetting.

InterpersonalandCommunicationSkills

Professionalism

Utilizetranslationservicestocommunicatewithnon-Englishspeakingpatientsasneeded. InterpersonalandCommunicationSkills

Systems BasedPractice

Demonstrateeffectivetime-managementskills. Practice-BasedLearningand Improvement

Follow uponconsultpatientsasneeded. PatientCare Systems BasedPractice

Professionalism

AttendmultidisciplinarySkullBaseTumorrounds. Systems BasedPractice

Goal2. ChronicOtitisMedia. Screen,diagnoseandmanagepatientswithsymptomssecondarytotheirchronicearinfections

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyofthemiddle earand mastoid,andthevariationsseenthatmayinfluenceoptimaltreatmentoptions.

MedicalKnowledge

Takearefinedhistoryfocusedonissuesrelatedtorecurrentandchronicearinfections. PatientCare

Describeandassesstheuseofdiagnostictestsforassessingotologicdisease(e.g.CTand MRIimaging,audiology,tympanometry). Refineefficiencyinorderingtests.

Beabletoassesstheexternalandmiddleearonexam, includingtheuseofthebinocular microscopeandotoendoscopy. Refinetheinterpretationofclinicalfindingstoformulatea treatmentplan.

PatientCare MedicalKnowledge Systems BasedPractice

PatientCare

Differentiatemiddleearfromexternaleardisease. PatientCare

Beabletocounselparentsaboutthepathophysiologyofconditionsassociatedwith chronicotitis,itsrisks,andtreatmentoptions.

Understandtheindicationsforsurgicalintervention,itsrisksandpotential complications. Understandhowhistoryandanatomyinfluencesurgicaltreatmentplanning.

Beabletocounselparentsabouttherisksandbenefitsoftympanomastoidsurgery,and obtaininformedconsentforplanned procedure.

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Professionalism InterpersonalandCommunicationSkills

Knowtheperioperativemanagementandexpectedpostoperativecourseofpatientswho undergotympanomastoidsurgery. Beabletoanswerthemajorityofpostoperative questions/concerns.

Beabletosafelyandefficientlyperformthemajorityof tympanomastoidsurgeryincluding mastoidectomy,transcanalprocedures,ossiculoplasty,etc.

PatientCare

PatientCare

Refinecomfortwithmastoidectomyandboneremovaltechniques;increasesafetyand efficiency. PatientCare

Beabletoassessoutcomesovertimeandformulateplansbasedontheevolutionofthe underlyingdisease.

Goal3.Vertigo. Beabletoevaluateandtreatperipheralvestibulardisease.

PatientCare

ResidentObjectives: ACGMECompetencyGoals

Beabletodescribetheanatomy,physiology,andpathophysiologyoftheperipheral vestibularsystem,andhowitimpactsclinicalpresentation.

Beabletotakeahistoryrelatedtobalanceandvertigo. Formulateadirectedandpractical differentialdiagnosis.

Knowhowtoperformclinicalexaminationofpatientswithvestibularcomplaints. Differentiateperipheralfromcentralpathology.

Understandtreatmentsavailableforacutevestibulardysfunctionintheclinicand emergencyroom.

Refineabilitytodiscussfactorsinvolvedinvertigoandbalancedysfunctionwithpatients andfamilies.

MedicalKnowledge

PatientCare

Interpersonaland CommunicationSkills

PatientCare

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Beabletocounselparentsaboutthevarioustreatmentoptionsavailableformanagement ofMeniere’sdisease,paroxysmalpositioningvertigo,andvestibularneuronitis,superior semicircularcanaldehiscence,etc.Discussmedicalvssurgicalapproaches,andformulate anunderstandingoftheroleofsurgeryinthesedisorders.

PatientCare

InterpersonalandCommunicationSkills

Beabletointerpretvestibularfunctiontests,andusetheminformingatreatmentplan. PatientCare MedicalKnowledge

Beabletodiscusscareofvertigopatientswithprovidersfromotherspecialtiesto formulateacareplaninvolvinganumberofdisciplines. Understandtheroleof otolaryngologistandotherspecialistsinthemanagementofvestibulardisorders.

Befamiliarwiththesurgicalmanagementofperipheralvestibulardisease,andbeableto performthemajorityofthestepsnecessaryfortheirsuccessfulcompletion.

Goal4.HearingLoss

Resident

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Objectives: ACGMEcompetencygoals

Beabletoobtainacomprehensivehearinglosshistoryandformulateatreatmentplan. PatientCare

Refinetheabilitytorecognize, describeandcategorizeacquiredandcongenitalhearing loss.

Knowthemostcommoncausesofsensorineuralvsconductivehearingloss.

Performanefficientphysicalexaminationfor hearingloss,includingtuningforkexam, otomicroscopy,cranialnerveexam,pneumo otoscopy,andknowwhnadditionaltestingis needed

Understandaudiometrictesting,andhowtofullyinterprettheirfindingstodirectcare. Refinetheabilitytodiscusspatientdatawithaudiologiststooptimizecare.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare

PatientCare MedicalKnowledge

Understandthebasicsofhearingaidtypes,styles,limitations,andthefittingprocess. PatientCare MedicalKnowledge

Understandtheoptionsofsurgicalcorrectionofconductivehearingloss(stapedectomy, ossiculoplasty)includingtheirindications,limitations,andtherelevantanatomic variationsthatcouldbeencounteredintraoperatively.

Gainadditionalfamiliaritywith intraoperativeevaluationofossicularchainmobility,and understandthereconstructiveoptionsthatareavailableforagivenpatient. Beableto placethemajorityofossicularprostheses.

PatientCare

PatientCare

Beabletoassesspatientsforpossiblecochlear implantation. Beabletodiscussthe indications,surgery,postoperativeexpectations,andneedforrehabilitationservices. Be abletoperformthemajorityofcochlearimplantationwithintraoperativesupervision.

Goal5. Neurotology. Diagnoseandmanagepatientswithskullbasedisease

ResidentObjectives:

Refinetheunderstandingofskullbaseanatomytounderstandthe influenceofanatomic andpathologicvariabilityontreatmentoptionsandpatientcare.

Beabletoobtainadetailedhistoryrelatedtoextra axialneoplasmsandotherlesionsof theinternalauditorycanal, cerebellopontineangle,temporalboneandposteriorfossa. Incorporaterelevantpatientdataintoanefficientandoptimizedcareplan.

Understandthesurgicalanatomy,signs,symptomsand clinicaldiagnosisoflesionsofthe petrousapex. Refineanunderstandingforwhichlesionsrequireimmediatetreatment,and whichdonot.

Understandtheinterpretationofradiologicstudiesusedtodiagnose lesionsofthe posterolateralskullbase. Beabletocombinedifferentmodalitiesinformulatinga diagnosis.

Beabletoeffectivelyuseancillarytests(e.g.angiography,electrodiagnosticstudies, nuclearstudies)toevaluateskullbaselesions.

Beabletoevaluateapatientwithvestibularschwannomaintheclinic,andformulatea reasonabletreatmentplanbasedonfindings,radiology,andpatientpreferences.

Beabletorecognizecomplicationsofcranialbasesurgery,includingvascularinjury,spinal fluidleak,cranialneuropathy,infection,andCNSinjury. Recognizethecausativefactors, andformulateabasicmanagementplan.

Refinetheabilitytocollaborateatahighlevelwithamultidisciplinaryteamtoprovide comprehensivecareforpatientswithskullbaselesions.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

ACGMECompetencyGoals

MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Understandtheoptionsforbenignlesionsofthepostero lateralskullbaseincluding watchfulwaiting,focusedradiation,andmicrosurgicalresection. Haveabasic understandingoftreatmentplanningfor stereotacticradiosurgery.

PatientCare MedicalKnowledge

Goal6.Audiology. Understandthemethodsavailabletotestthehearing,andhowtointerpretthetests.

ResidentObjectives: ACGMEcompetencygoals

Befamiliarwiththe indicationsforvariousaudiometrictestsincludingpure-tonetesting, wordrecognitionsscores,reflextesting,tympanometry). Understandhowtousethese testsefficientlyinthecontextofclinicalfindings.

Befamiliarwithinterpretingaudiometrictesting,includingtheiraccuracy,reliability,and impactonclinicalcare.

Beabletoperformroutinetympanogramsandaudiograms.

Understandspecializedelectodiagnosticstudiesandtheirindications(includingABR, ECOG,VEMP,rotationalchair,posturographytesting,VNG,etc). Understandhowtheycan guidefurthertreatment.

Goal7.FacialNerve

Resident

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Objectives: ACGMEcompetencygoals

Understandthesurgicalanatomyofthefacialnerveanditscommondisorders,including theirnaturalhistory,clinicalpresentation,evaluationandtreatment.

Beabletoidentifyanddecompresstheintratemporalfacialnervewithsupervisionas clinicallyindicated. Beabletoperformthemajorityoffacialnerveneurorrhaphy,including donorgraftharvest.

Goal8. GeneralOtology

ResidentObjectives

Beabletoobtainanappropriatehistoryregardingexternaleardisease. Understand cutaneousdisordersthatmayberelatedandtheindicationsforbiopsy.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

ACGMECompetencyGoals

PatientCare InterpersonalandCommunicationSkills

Becomemorecomfortablewithclinicalotologicproceduresincludingmyringotomy,and intratympanicinjections. Befamiliarwithlocalanestheticusedforoutpatientotologic procedures.

Beabletodiscussthebasicsofintratympanictreatment,includingtheprocedure,itsrisks, benefits,andexpectations.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Beabletoeffectivelyevaluateandtreatthemajorityofpatientscomplainingoftinnitus. PatientCare MedicalKnowledge

Refinetheapproachtopatientswithotalgia,includinganunderstandingofwhentoinvolve consultationfornon otologicetiologies.

Refinetheinteractionwithotherrelatedconsultservicesforpatientswithotologic complaints.

Furtherdevelopanunderstandingofandsensitivitytotheimpactofcultural,economic andethnicfactorsinthedoctor patientrelationshipandthedeliveryofotologiccare.

Developanimprovedunderstandingofone’sownabilitiesandlimitationsincluding awarenessofsignsoffatigue.

Becomeamoreintelligentuseroftheacademicliteratureinotolaryngology. Demonstrate theabilitytoapplyknowledgeofstudydesignsand statisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

DevelopanunderstandingofOHNScodingand complianceissuesinotology/neurotology.

PatientCare MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

Professionalism Systems BasedPractice

Professionalism

Professionalism Practice BasedLearningandImprovement

Professionalism Systems BasedPractice

Goal9. Nasalcavityandsinuses. Diagnoseandmanagepatientswithnasalproblems.

ResidentObjectives

BefamiliarwiththeEMRatStanford(EPIC)toconfidentiallyaccessappropriatepatient information,pastcultureresults,pathologyreportsandpastimagingstudies.

ACGMECompetencyGoals

PatientCare Professionalism Systems BasedPractice

Evaluateconsultpatientswithsinonasaldisorderswith theseniorresidentsandfaculty.Be abletodocumentandcommunicaterecommendationsandplanwiththeprimaryteamin aprofessionalandcourteousmanner.

PatientCare MedicalKnowledge Systems-BasedPractice Interpersonaland CommunicationSkills

Knowtheanatomy,pathophysiology,anddevelopmentofthenasalcavityandsinuses. MedicalKnowledge

Performliteraturesearchestoinvestigatecommonandrarepatientpresentations,andto obtainevidenceforcurrent practiceparadigmsinpatientcare.

UnderstandprinciplesandutilityofCTversusMRIimagingofthesinuses.Understandand describeanatomicvariationsofthe4pairsofparanasalsinuses,patternsofuncinate processattachmentandsinusdrainagepatterns.

Beabletoobtainadetailedhistoryrelatedtothenoseandnasalproblemsrelatedtosinus diseaseand allergicrhinitis.

Performsafe,informativeroutineofficenasalendoscopywith0degreeand30degreerigid endoscopes.

AccessandunderstandAAOdescriptiveguidelinesforacute, subacuteandchronic sinusitis,andknowthemajorandminorsymptomsassociatedwithdiagnosisofsinusitis.

Evaluatepatientswithchronicsinusitiswithandwithoutpolyposis anddistinguishwhich patientsmayrequiresurgeryormedicaltherapy.

MedicalKnowledge Practice BasedLearningandImprovement

Professionalism

MedicalKnowledge InterpersonalandCommunicationSkills

PatientCare InterpersonalandCommunicationSkills

PatientCare

MedicalKnowledge Systems BasedPractice

PatientCare MedicalKnowledge Professionalism

Beabletodescribeandrecognizecomplicationsofacutesinusitis.

Identifythesignsandsymptomsanddifferencesbetweenallergicrhinitisand acute/chronicsinusitis.

Understandindicationsforsafeintranasalofficebiopsy.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beproficientwiththeevaluationandmanagementalgorithmsfortreatingepistaxis. PatientCare

MedicalKnowledge

Understandoptionsfortreatmentofnasalseptaldeviationandturbinatehypertrophy. PatientCare MedicalKnowledge

Learntheassemblyofequipmentneededtoperformnasalendoscopy,andintraoperative imageguidance. PatientCare MedicalKnowledge

Completebasicaspectsofendoscopicapproachestothenasalcavity –includinguseof zero-degreeand30degree endoscopes,safelynavigatingthenasalcavitywithmucosal preservingtechnique,performingseptoplasty,turbinatereduction,maxillaryantrostomy, andanteriorethmoidectomy.

Goal10.Understandthebasicsofthe aestheticpatientconsultation

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Understandandbeabletoperformpsychologicalassessmentforpotentialaesthetic surgerypatients. MedicalKnowledge PatientCare

Describehowtoperformoutpatientfillerorbotulinumtoxininjections. MedicalKnowledge

Knowliteratureregardingefficacyoffacialrejuvenationprocedures. MedicalKnowledge

Understandbasicmedicalphotography. MedicalKnowledge

Goal

11.Understandtheapproachtotherhinoplastypatient

ResidentObjectives: ACGMECompetencyGoals

Understandandprovidepsychologicalassessmentforpotentialrhinoplastypatients. MedicalKnowledge PatientCare

Understandanatomyoftheinternalandexternalnasalvalveandrepair. MedicalKnowledge

Knowliteratureregardingefficacyofnasalsurgicalprocedures. MedicalKnowledge

Understandbasicaestheticnasalanalysis. MedicalKnowledge

Goal

12.Understandtheapproachtothefacialtraumapatient

ResidentObjectives: ACGMEcompetencygoals

Beabletoassessandperformsofttissuerepair. MedicalKnowledge PatientCare

Understandpathophysiologyoffacialfracturesandprovideeffectiveplanofcare. MedicalKnowledge PatientCare

Understandthebiomechanicsoffixationforfractures MedicalKnowledge PatientCare

Knowliteratureregardingfacialtrauma. MedicalKnowledge PatientCare

Goal13.Understandtheapproachtothefacial nervetraumapatient

ResidentObjectives: ACGMECompetencyGoals

Beabletoexploretheextratemporalfacialnerve. MedicalKnowledge

Beabletodiscussoptionsfortreatmentoffacialnerveparalysis. MedicalKnowledge PatientCare InterpersonalandCommunicationSkills

GoalsandObjectivesPGY5: SHCSpecialtyService

Competency-basedGoalsandObjectives

Goal1. Consultsinanadulthospital. Continuetolearnaboutconsultsrequestedregardingotologicproblems.

ResidentObjectives: ACGMECompetencyGoals

ProvidebackupresidentevaluationforallconsultsfromotherSHCservicesandthe emergencydepartment. Effectivelyoverseethediscussionof allconsultsondailyrounds.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Professionalism Systems BasedPractice

Seeconsultpatientsasindicated,and formulateaplanforcare. Discusswithattending staffasneeded. Overseetheimplementationofallclinicalplans.

DevelopacomprehensiveunderstandingoftheSHCelectronicmedicalrecord(Epic)and beabletoaccessinformationappropriately. Understandtheimportanceofconfidentiality inpatientmedicalrecords.Providebackupandinstructionfortheotherresidentteam membersforitsuse.

Learntoeffectivelyrunaninpatientservice. Understandhowtoassigndutiesappropriate foreachresident’sleveloftraining. Provideadministrativeleadershiptocoverconsults, operativecases,andoutpatientclinic.

Establishcompetencyasaleaderforteachingonroundsandassigningacademicdutiesto theresidentteam.

Understandhowtooverseeallcommunicationsbetweentheresidentserviceandother serviceswhosharecommonpatients. Learnhowtobeaccurate,professional,andefficient intheseinteractions.

PatientCare MedicalKnowledge

PatientCare Professionalism Systems-BasedPractice

PatientCare MedicalKnowledge Systems BasedPractice

InterpersonalandCommunicationSkills

MedicalKnowledge Practice BasedLearningandImprovement

InterpersonalandCommunicationSkills Professionalism

Establishleadershipskillsinplanningacademicmeetings,conferences,andschedules.

Refineeffectivetime managementskillsgivenexpectedadditionaltime constraints imposedbyacademicduties.

Learntointegratevariedpatientcarestylesfromdifferentattendings,andusetheseto developpersonalpreferences.

LeadSkullBaseTumorroundsdiscussions,understandissuesexamined,andimplement decisionsasrequired.

InterpersonalandCommunicationSkills

Systems BasedPractice

Practice BasedLearningandImprovement

PatientCare Systems BasedPractice

Professionalism

Systems-BasedPractice

Goal2. ChronicOtitisMedia. Screen,diagnoseandmanagepatientswithsymptomssecondarytotheir chronicearinfections.

ResidentObjectives: ACGMECompetencyGoals

Developacomprehensiveunderstandingofthesurgicalanatomy,physiology,and pathophysiologyofthemiddleearandmastoid. Thedepthofunderstandingshouldallow theresidenttooperateindependentlyinthegreatmajorityofchronicearprocedures.

MedicalKnowledge Takearefinedhistoryfocusedonissuesrelatedtorecurrentandchronicearinfections,and formulateanoptimizedplanofcare.

PatientCare Orderandinterpretdiagnostictestsforassessingotologicdisease(e.g.CTandMRI imaging,audiology,tympanometry). Refineefficiencyinorderingtestsandestablish individualizedprotocolsformanagingchroniceardisease.

PatientCare MedicalKnowledge Systems BasedPractice

PatientCare Beabletoteachjuniorresidentsandmedicalstudentsthebasicsofmiddleeardisease. PatientCare Refinetheabilitytocounselparentsregardingthepathophysiologyofconditions associatedwithchronicotitis,itsrisks,andtreatment options.

Beabletoassesstheearonexam. Developmasteryofthebinocularmicroscopeand otoendoscopy. Understandwhatfindingsnecessitateoperativeintervention,andwhich canbetreatedintheoutpatientclinic.

PatientCare InterpersonalandCommunicationSkills

Understandtheindicationsforsurgicalintervention,itsrisksandpotentialcomplications. Understandhowhistoryandanatomyinfluencesurgicaltreatmentplanning. Beableto formulateanindependentplanformanagementofbroadcategoriesofmiddleeardisease.

Beabletoappropriatelymanipulateevendifficultearsintheclinicwithaminimumof patientdiscomfort.Developtheconfidenceandreassuringtonetoenablethis.

Knowthemanagementandexpectedpostoperativecourseofpatientswhoundergo tympanomastoidsurgery.Beabletoanswerthepostoperativequestions/concerns,and arrangeforappropriatefollow upcare.

Beabletosafelyandefficientlyperformthemajorityoftympanomastoidsurgeryincluding mastoidectomy,transcanalprocedures,ossiculoplasty,etc.

Beabletosafelyworkinanatomicallychallengingmiddleearswithunconventional anatomy.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills PatientCare

PatientCare

PatientCare

PatientCare

Beabletotakejuniorresidentsthroughthebasicstepsoftympanomastoidsurgery. PatientCare Developacomprehensiveunderstandingofthenaturalhistoryofchroniceardiseaseand itsresponsetotreatment. PatientCare

Goal3.Vertigo. Beabletoevaluateandtreatperipheralvestibulardisease.

ResidentObjectives: ACGMEcompetencygoals

Refinetheunderstandingoftheanatomy,physiology,andpathophysiologyofthe vestibularsystem(bothperipheralandcentral),andhowitimpactsclinicalpresentation.

Beabletotakeahistoryrelatedtobalanceandvertigo. Formulateadirectedandpractical differentialdiagnosis.

Knowhowtoperformclinicalexaminationofpatientswithvestibularcomplaints. Differentiateperipheralfromcentralpathology.Incorporatetheinterpretationof specializedvestibulartests.

Beabletoformulate,presentandcarryoutanincrementalapproachtotreatingperipheral vestibulopathy.

MedicalKnowledge

PatientCare

Interpersonaland CommunicationSkills

PatientCare

PatientCare

MedicalKnowledge

Refinetheabilitytodiscussfactorsinvolvedinvertigoandbalancedysfunctionwith patientsandfamilies.

PatientCare InterpersonalandCommunicationSkills MedicalKnowledge

Beabletocounselparentsaboutthevarioustreatmentoptionsavailableformanagement ofMeniere’sdisease,paroxysmalpositioningvertigo,andvestibularneuronitis,superior semicircularcanaldehiscence,etc. Discussmedicalvssurgicalapproaches,andformulate anunderstandingoftheroleofsurgeryinthesedisorders.

Beabletointerpretthesubtletiesofvestibularfunctiontests(VNG,VEMP,ECOG,etc),and usetheminformingatreatmentplan.

Beabletodiscusscareofvertigopatientswithprovidersfromotherspecialtiesto formulateacareplaninvolvinga numberofdisciplines. Understandtheroleof otolaryngologistandotherspecialistsinthemanagementofvestibulardisorders.

Befamiliarwiththesurgicalmanagementofperipheral vestibulardisease,andbeableto performthemajorityofthestepsnecessaryfortheirsuccessfulcompletion including selectivecanalplugging,vestibularneurectomy,andlabyrinthectomy.

Goal4.HearingLoss

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

Interpersonaland CommunicationSkills

ResidentObjectives: ACGMEcompetencygoals

Beabletoobtainacomprehensivehearinglosshistoryandformulateatreatmentplan. PatientCare Refinetheabilitytorecognize,describeandcategorize acquiredandcongenitalhearing loss.

PatientCare MedicalKnowledge

Beabletoformulateanappropriateandcost-effectivework-upforretrocochleardiagnosis, andevaluationofcongenitalhearingloss. PatientCare Systems BasedPractice

Performanefficientphysicalexaminationforhearingloss,includingtuningforkexam, otomicroscopy,cranialnerveexam,pneumo otoscopy,andknowwhenadditionaltesting isneeded.

Understandaudiometrictesting,andhowtofullyinterpret theirfindingstodirectcare. Refinetheabilitytodiscusspatientdatawithaudiologiststooptimizecare.

PatientCare

PatientCare MedicalKnowledge

Understandthebasicsofhearingaidtypes,styles,limitations,andthefittingprocess. Have abasicunderstandingofhowtoincorporatehearingaiddispensingintoanotolaryngologic practice.

Understandtheoptionsofsurgicalcorrectionofconductivehearingloss(stapedectomy, ossiculoplasty)includingtheir indications,limitations,andtherelevantanatomic variationsthatcouldbeencounteredintraoperatively.

PatientCare MedicalKnowledge

PatientCare

PatientCare Becomfortableinevaluatingcochlearimplantcandidates. Beabletodiscussthe indications,surgery, postoperativeexpectations,andneedforrehabilitationservices. Presentthedifferenttypeofdevicesavailable,andunderstandcurrentareasofclinical researchthatmayimplantcare. Beabletoperformthemajorityofcochlearimplantation.

Gainclinicalcompetenceintheintraoperativeevaluationofossicularchainmobility,and understandthereconstructiveoptionsareavailableforagivenpatient. Beabletoplace theossicularprostheses. Beabletoperformthemajorityofuncomplicatedstapessurgery.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Goal5. Neurotology. Diagnoseandmanagepatientswithskullbasedisease

ResidentObjectives: ACGMECompetencyGoals

Refinetheunderstandingofskullbaseanatomyto understandtheinfluenceofanatomic andpathologicvariabilityontreatmentoptionsandpatientcare. Beabletolisttheclinical andradiographicpresentationofskullbaselesions.

PatientCare

MedicalKnowledge Refinetheabilitytoobtainadetailed historyrelatedtoextra-axialneoplasmsandother lesionsoftheinternalauditorycanal,cerebellopontineangle,temporalboneandposterior fossa. Incorporaterelevantpatientdataintoanefficientandoptimizedcareplan.

Understandthesurgicalanatomy,signs,symptomsandclinicaldiagnosisoflesionsofthe petrousapex,clivus,andjugularforamen. Refineanunderstandingforwhichlesions requireimmediatetreatment,andwhichdonot.

Understandtheinterpretationofradiologicstudiesusedtodiagnoselesionsofthe posterolateralskullbase. Beabletocombinedifferentmodalitiesinformulatinga diagnosisandappropriatetreatmentplan.

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletoeffectivelyorderandinterpretancillarytests(e.g.angiography,electrodiagnostic studies,nuclearstudies)toevaluateskullbaselesions. Discussthefindingseffectivelywith radiologists.

Beabletoevaluateapatientwithvestibularschwannomaandsimilarlesions,and formulateareasonabletreatmentplanbasedonfindings,radiology,andpatient preferences. Formulateawork upandtreatmentplanfor patientswithNF 2.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletorecognizecomplicationsofcranialbasesurgery,includingvascularinjury,spinal fluidleak,cranialneuropathy,infection,andCNSinjury. Recognizethecausativefactors, andformulateabasicmanagementplan. Understandmethodsandtehniquestoavoid suchcomplications.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge Refinetheabilitytocollaborateatahighlevelwithamultidisciplinaryteamtoprovide comprehensivecareforpatientswithskullbaselesions.

InterpersonalandCommunicationSkills

Understandtheoptionsforbenignlesionsofthepostero lateralskullbaseincluding watchfulwaiting,focusedradiation,andmicrosurgicalresection. Befamiliarwith treatmentplanningforstereotacticradiosurgeryforuncomplicatedlesionsofthecranial base.

Beabletoperformthemajorityofsurgicalapproachestothecranialbase including transmastoidapproachestothejugularforamen,petrousapicectomy,translabyrinthine approaches,andmiddlefossacraniotomy.

PatientCare MedicalKnowledge

PatientCare

Goal6.Audiology. Understandthemethodsavailabletotestthehearing,andhowtointerpretthetests.

ResidentObjectives: ACGMECompetencyGoals

Befamiliarwiththeindicationsforallusedaudiometrictestsincludingpure tonetesting, wordrecognitionsscores,sentencetesting,reflextesting,tympanometry). Understand howtousethesetestsefficientlyinthecontextofclinicalfindings.

Befamiliarwithinterpretingaudiometrictesting,includingtheiraccuracy,reliability,and impactonclinicalcare.

Beabletoperformroutinetympanogramsandaudiograms.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Understandspecializedelectodiagnosticstudiesandevokesresponsesandtheir indications(includingABR,ECOG,VEMP,rotationalchair,posturographytesting,VNG,etc). Understandhowtheycanguidefurthertreatment.

Goal7.FacialNerve

ResidentObjectives:

Understandthesurgicalanatomyofthefacialnerveanditscommondisorders,including theirnaturalhistory,clinicalpresentation,evaluationandtreatment.

Beabletofindanddecompresstheintratemporalfacialnervewithsupervisionasclinically indicated. Beabletoperformthemajorityoffacial nerveneurorrhaphy,includingdonor graftharvest. Becomfortablewithtechniquesoffacialnervere routing.

Goal8. GeneralOtology

PatientCare MedicalKnowledge

ACGMECompetencyGoals

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

ResidentObjectives: ACGMECompetencyGoals

Beabletoindependentlymanage uncomplicatedcutaneouslesionsoftheexternalear canalandpinna. Beabletocommunicatethetreatmentoptionsandexpectationswiththe patient.

Beabletoperformclinic basedotologicproceduresincludingmyringotomy,and intratympanicinjections. Befamiliarwithlocalanestheticusedforoutpatientotologic procedures.

Beabletodiscussthebasicsofintratympanictreatment,includingthe procedure,itsrisks, benefits,andexpectations.

PatientCare InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Beabletoeffectivelyevaluateandtreatthemajorityofpatientscomplainingoftinnitus andthespectrumofothernon surgicalotologiccomplaints.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge Furtherrefinethecareofotalgia,includinganunderstandingofwhentoinvolve consultationfornon-otologicetiologiesandwhentoconsultotherspecialists(painservice, oralsurgery,laryngology,etc).

Beabletoteachjuniorresidentsandmedicalstudentsintheapproachtooutpatient otology.

PatientCare InterpersonalandCommunicationSkills

Furtherdevelopanunderstandingofandsensitivitytotheimpactofcultural,economic andethnicfactorsinthedoctor-patientrelationshipandthedeliveryofotologiccare.

Developanimprovedunderstandingofone’sownabilitiesandlimitationsincluding awarenessofsignsoffatigue.

Becomeamoreintelligentuseroftheacademicliteratureinotolaryngology. Demonstrate theabilitytoapplyknowledgeofstudydesignsandstatisticalmethodstoappraiseclinical studies. Performliteraturesearchesasneededtocontinuouslyimprovethelevelof medicalknowledge.

DevelopanunderstandingofOHNScodingand complianceissuesinotology/neurotology.

Goal9.Understandthebasicsoftheaestheticpatientconsultation

Professionalism Systems BasedPractice

Professionalism

Professionalism Practice-BasedLearningandImprovement

Professionalism Systems-BasedPractice

ResidentObjectives: ACGMECompetencyGoals

Beabletoperformablepharoplasty(upperorlower). MedicalKnowledge PatientCare

Goal10.Understandtheapproachtotherhinoplastypatient

ResidentObjectives: ACGMECompetencyGoals

Beabletoperformaneffectivefunctionalor aestheticseptorhinoplasty. PatientCare MedicalKnowledge

Goal11.Understandtheapproachtothefacialtraumapatient

ResidentObjectives: ACGMEcompetencygoals

Beabletoperformrepairof frontalsinus,naso orbito ethmoidal,maxillary,orbital,and mandibularfractures. PatientCare MedicalKnowledge

Goal12.Understandtheapproachtothefacialtraumapatient

ResidentObjectives: ACGMEcompetencygoals

Beabletoperformacanthoplastyandgoldweightprocedure. MedicalKnowledge PatientCare

Goal13. Nasalcavityandsinuses. Diagnoseandmanagepatientswithnasalproblems.

ResidentObjectives: ACGMECompetencyGoals

BefamiliarwiththeEMRatStanford(EPIC)to confidentiallyaccessappropriatepatient information,pastcultureresults,pathologyreportsandpastimagingstudies.

PatientCare Professionalism Systems-BasedPractice

Effectivelycomprehensivelymanageprimaryinhouse, post operativeandconsultpatients withsinonasaldisorderswiththejuniorandseniorresidents.

Knowtheendoscopicanatomyand pathophysiologyofthesinuses,paranasalskullbase, andextendedskullbaseincludingpterygopalatinefossa,infratemporalfossa,orbit,sella, lateralsphenoidrecess,clivusandanteriorskullbase.

Performliteraturesearchestoprepareforpublicpresentationsonrhinologytopics,and effectivelypresentinqualityassuranceconferencesinaprofessionalandcomposed manner.

UnderstandradiographicnuancesofsinonasaldiseaseprocessesusingbothCTversusMRI imaging sinonasalneoplasms,intraorbitalpathology,pneumocephalus,suprasellar intracranialdisease.

Understandtheposterior,lateral,inferior,andsuperiorlimitsofendoscopicapproachesto theskullbase

Understandfungalsinusitis,includingfungalballversusallergicfungalsinusdiseaseversus invasivefungalsinusitis.

Evaluatepatientswithchronicsinusitiswithandwithoutpolyposis anddistinguishwhich patientsmayrequiresurgeryormedicaltherapy.

Evaluatepatientswithchronicsinusitiswhohavereceivedpriorsurgery.Understand indicationsforrevisionsurgicalproceduresversususeofmedicaltherapies.

PatientCare MedicalKnowledge Systems BasedPractice InterpersonalandCommunicationSkills

MedicalKnowledge

MedicalKnowledge Practice BasedLearningandImprovement Professionalism

MedicalKnowledge InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

MedicalKnowledge Systems BasedPractice

PatientCare MedicalKnowledge Professionalism

PatientCare MedicalKnowledge Professionalism

Performproperofficedebridementofthemaxillary,ethmoid,sphenoidandfrontalsinuses intheimmediatepost operativesettingwith minimalpatientdiscomfort.

Understandtheetiologyofsinusitisinthesettingofimmunosuppression,andsurgically managepatientswithinvasivefungalsinusdisease.

Identifythesignsandsymptomsofmorerareintranasalpathology,suchasautoimmune disease(Wegener’s)andgranulomatous(Churg-Strauss)disease.

Understandanddescribecomplicationsofendoscopicsinussurgery,includingorbital injury,CSFleak,synechiaeformation,middleturbinatelateralizationandneedforrevision surgery.Beabletoeffectivelyandcompassionatelycounselpatientsofthese details.

Utilizemoreadvancedequipmentandinstrumentationtoaccessthenasalcavity includinguseof30,45,and70degreeendoscopestoaccessareasofthenasal cavity,useof handinstrumentationandpoweredinstrumentssuchasmicrodebridersanddrills,and endoscopiccauterytools.

Performsafeandmethodicalendoscopicsinussurgery,includingskullbasedissection, frontalsinusotomy,modifiedLothropprocedure,andrevisionendoscopicsinussurgery.

Understandprinciplesandtechniquesforperformingopenskullbasesurgery,including frontalsinusobliteration, cranialization,andReidelprocedures.

Demonstrateappropriatesurgicaltechniqueforadvancedendoscopicorbitalsurgery, includingendoscopicdacrocystorhinostomy(DCR)andorbitaldecompression.Work effectivelywiththeOpthalmologyservicetocoordinatepatientintraoperativelyandonthe floors.

Understandandappropriatelyusereconstructiveladdersforintranasalandskullbase lesions,includingfreetissuegrafts,pedicledmucosaltissueflaps, pericranialflaps,and freeflaps.

Performsafeandefficientendoscopicresectionofanteriormidlineskullbasepathology withreconstruction.Workcloselyandeffectivelywithaneurosurgicalservicein coordinatedsurgicaleffortswhenrequired.

PatientCare MedicalKnowledge Professionalism

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge InterpersonalandCommunicationSkills

HALF-TIMERESEARCHRESIDENT

• ResearchResidentmusthaveatleast2.5daysofresearchtimeperweekonaverage.

• DuringPGY2orPGY4’svacation/conference/interviewperiod,Half-timeResearchResidentusuallyworksasfulltime.

SantaClaraValleyMedicalCenter

RotationContactsand SchedulingDetails

RotationDirector: MishaAmoils,MD Misha.Amoils@hhs.sccgov.org

Attendings:Amoils,Lalakea,Munoz,Saste,Shepard

Introduction

SantaClaraValleyMedicalCenterislocated25minutessouthofStanfordUniversity,andisacountyhospitalfacility.Rotationsatthisfacility complementtheresidencyexperiencebyprovidingexposuretoaculturallydiverse,medicallyindigentpopulationwithabroad rangeof OTO/HNSpathology.

TheR2residentshouldreviewtheR3ResearchRotationGoalsandObjectives. TheresearchplanmustbecompletedduringtheR2year.

AdditionalRequiredConferences:

o AllVMCOTO/HNSTeachingConferences:

o OTO/HNSRadiologyConference,OTO/HNSPathologyConference(eachconferenceoncemonthly).

o MonthlyStanfordFacultymeetings(ChiefResidents)

6:00-7:00 Rounds Rounds Rounds Rounds Rounds 8:00-9:00 ResEdatStanford AllDay 6:00-18:00 InpatientconsultsforR2andR5residents Clinic 8:00-12:00 GenClinic GenClinic GenClinic GenClinic GenClinic Saste Saste,Amoils Lalakea,Munoz Shepard,Munoz Saste 12:00-16:00 GenClinic GenClinic GenClinic GenClinic GenClinic Amoils,Lalakea Amoils,Shepard Lalakea Munoz Amoils 12:00-13:00

Radiologyconference (Every4th Thursday) Pathologyconference (Every2ndThursday) OR

8:30-17:30 ORShepard(4th Saste) 7:30-17:30 ORLalakea 7:30-17:30 ORAmoils 7:30-17:30 OR1st,3rd,5th:Saste 7:30-17:30 ORMunoz 18:00-19:00 GrandRoundsat Stanford 2nd residenttoassistinORM,T,W,Th,Fafternoonsatconclusionofclinic.

RotationSpecifics

1. Rounding:ResidentsareexpectedtorounddailybeforeO.R.anddailyafterclinic/OR. Residentsareexpectedtorounddaily on weekends generallybeginningbeforenoon.Thechiefresidentisexpectedtoteachjuniorresidentswhileonrounds.

2. Theattendingoncallshouldbephonedafterroundsandgiventhepatientupdate. Callotherattendingsasneededforspecific patientissues.

3. Theattendingoncallshouldbecalledaboutalladmissionstothehospitals,allpatientsgoingtotheoperatingroomandall complicatedeveningornighttimeconsults.

4. Consultpatientsshouldbeseenandevaluatedwithin½dayofreceivingthe consultanddiscussedwiththeattending. Attending willsignoffwithin24hours.

5. ORcasesshouldbecoveredbytheappropriatelevelresidentswithattendingfacultypresent. Residentsareexpectedtohand downcasesasappropriate.Operativereportsshouldbedictated/typedthedayoftheprocedure.

6. Casesgoingonafter5 pmshouldbecoveredbytheon callresidentiflocaltoValley,otherwisetheappropriatelevelresident. Ifa seniorlevelcaseisgoingonandnoclinicsareinprocessthenajuniorresidentisencouragedtoscrubinandassistwithcase.

7. Pre opsshouldbereviewedtheweekprior. Residentsareexpectedtoknowthepatientinformation.

8. Residentsarereleasedfromdutywhentheworkisdonewithattentiontoresidentworkhoursandpatientcare.

9. ChiefresidentsareexpectedtoattendthemonthlyStanfordfacultymeetings.

EvaluationandFeedback

TheSantaClaraValleyMedicalCenterfaculty,andselectedancillarymedicalpersonnelwillcompletewrittenevaluationsat theendofthe rotation. Selectedclinicpatientswillevaluatetheresidents.ResidentswillbeaskedtoevaluateeachFacultyMemberand therotation. Daily feedbackonphysicalfindings,assessment,plan,andsurgicaltechniquewilloccurthroughclinicalinteractions.

GoalsandObjectivesPGY2: SCVMC

Competency-basedGoalsandObjectives

Goal1: Learnhowtoevaluateandcounselotolaryngologypatientswithcommonconditionsrelatedtotheheadandneck.

ResidentObjectives: ACGMECompetencyGoals

Regularlyattendoutpatientclinicsandlearnacompleteheadandneckhistoryand examinationonadultandpediatricpatientswithattendingsupervision/verificationof positive/negativefindings.

Begintoattainanunderstandingofappropriatework upandavailablemedicaland surgicaltreatmentoptionsforadultswithcommonconditionssuchaschronicotitis media,nasalobstruction,sleepapnea,chronicsinusitis, gastroesophagealreflux, asymmetricsensorineuralhearingloss,vocalcordparalysis,epistaxis,headandneck malignancy,andotitisexterna.

PatientCare MedicalKnowledge

PatientCare MedicalKnowledge

Beabletoeffectivelycounselpatientsregardingthetreatment alternatives,indications, risks,benefits,andexpectedpost operativecourseofbasicsurgicalproceduressuchas: PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

o Uvulopalatopharyngoplasty

o Septoplasty

o Turbinatereduction

o Tracheotomy

o Tympanostomytubeplacement

o Intracapsularversustotaltonsillectomy

o Excisionalbiopsyofneckmass

o Laryngoscopy,esophagoscopy,andbronchoscopy

Beabletoeffectivelycounselpatients regardingmedicalENTtopicssuchaspresbycusis, tinnitus,controlofseasonalallergies,headandneckcancerriskfactors,andsmoking cessation.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills

Learnbasicaudiologicprinciplesandunderstandtheinterpretationofaudiologictests. MedicalKnowledge

Begintodevelopapracticalandcost-effectiveapproachtoprovidingexcellentcarewithin theconstraintsofresourcesavailabletouninsured/under insuredpatients.

Systems-BasedPractice PatientCare

Begintodevelopcompetencyinrecognizingemergenciesintheadultandpediatric patient,includingairwayemergencies.

PatientCare

Learnthenuancesofperformingfiberopticnasopharyngoscopyand laryngoscopy. PatientCare

Learntoperformpneumaticotoscopytoimproveaccuracyinthediagnosisofmiddleear effusion. PatientCare

Learnthewaysinwhichnormalpediatricanatomymaydifferfromadultanatomy,andthe appearanceofcommonpediatricdisorders. MedicalKnowledge

Learntoobtainadirectedhistoryandexamforcommonpediatricproblemssuchassleep apnea,hearingloss,speechdelay,epistaxis,andstridor.

Beabletodiscussappropriatework upandmanagementforpediatricconditionssuchas otitismedia,sleepdisorders,sinusitis,laryngomalacia,recurrentrespiratory papillomatosis,andneckmasses.

Beabletoeffectivelycounselpatients/familiesregardingthetreatmentalternatives, indications,risks,benefits,andexpectedpostoprecoveryofthefollowingprocedures:

o Pressureequalizingtubeplacement

o Tonsillectomy

o Adenoidectomy

o Laryngoscopyandbronchoscopy

o Excisionofneckmass(e.g.thyroglossalductcyst)

o Tracheostomy

o Tympanoplasty

Beabletoeffectivelycounselpatients/familiesregardingmedicalENTtopics suchas congenitalhearingloss,riskfactorsforotitismedia,second handsmokerisks,epistaxis prevention.

Developasenseofempathyregardingthebarriersthatconspiretoprevent patientsfrom receivingoptimalhealthcare(lackoftransportation,languagebarriers,socioeconomic status,culturaldifferences,educationlevel,familysupport,etc.).

Understandtheimportanceofconfidentialityinpatientmedicalrecords,patientcare,and patientrelatedcommunications.

PatientCare

InterpersonalandCommunicationSkills

PatientCare MedicalKnowledge

PatientCare

InterpersonalandCommunicationSkills

PatientCare

InterpersonalandCommunicationSkills

PatientCare

InterpersonalandCommunicationSkills

Professionalism

Professionalism

InterpersonalandCommunicationSkills

Begintodevelopanunderstandingofone'sownabilitiesandlimitations,including fatigue-management,andacommitmenttolife-longlearningandimprovement.

Becomeacompetentuseroftheliteratureinotolaryngology,through targetedliterature searchesandcriticalreviewofliterature,todirectpatientcareandimprovemedical knowledge.

Practice BasedLearningandImprovement

Professionalism

Practice-BasedLearningandImprovement

DevelopanunderstandingofOHNSdocumentation,codingandcomplianceissues. Systems BasedPractice Professionalism

Goal#2: Learntoperformbasicotolaryngologyprocedures

ResidentObjectives: ACGMECompetencyGoals

Beabletocompetentlyperformthefollowingprocedureswithdirectattending supervision:

o Tympanostomytubeplacement

o Tonsillectomyandadenoidectomy

o Endoscopy,includingdirectlaryngoscopy,suspensionlaryngoscopy,esophagoscopy, andbronchoscopyinchildrenandadults

o Routinetracheotomy

o Removalofsimpleneckmasses/cysts

o Repairofcomplexfaciallacerations

o Removalofuncomplicatedesophagealforeignbodies

o Incisionanddrainageofneckabscess

Beabletoassembletheequipmentneededtoperformalaryngoscopy,bronchoscopyand esophagoscopy.

Learntosetup,test,andoperatetheCO2laserwithappropriateattentiontolasersafety, withsupervision.

PatientCare

PatientCare

PatientCare

Goal#3: Begintoappreciatesystems-basedunderstandingofotolaryngologypracticeandgeneralOHNS issues

ResidentObjectives:

Attendmonthlystaffmeeting.

BegintoappreciateimportanceofE&Mandprocedurecoding,surgicalprocedures, consultations,andoutpatientvisits(CPTandICD-10).

Begintounderstandtheimportanceofdocumentationtosupportcodinglevelsandto complywithinsurancepayorregulations(e.g.Medicare).

ACGMECompetencyGoals

Systems-basedpractice

Systems BasedPractice Professionalism

Systems BasedPractice

Professionalism

Begintodevelopsenseofempathyregardingthebarriersthatconspiretoprevent patientsfromreceivingoptimalhealthcare(lackoftransportation,languagebarriers, socioeconomicstatus,culturaldifferences,educationlevel,familysupport,etc.)

Understandtheimportanceofmaintainingconfidentialityinpatientmedicalrecords, patientcare,andpatientrelatedcommunications.

PatientCare

InterpersonalandCommunicationSkills

Professionalism

Professionalism

InterpersonalandCommunicationSkills

Goalsand ObjectivesPGY5: SCVMC

Competency-basedGoalsandObjectives

Goal#1: Knowhowtoevaluate,counselandtreatotolaryngologypatients.

ResidentObjectives: ACGMECompetencyGoals

Exhibitconfidenceandindependencewhilepursuinga well reasonedapproachtothe evaluationandmanagementofthefullspectrumofOTO/HNSpatients.

Professionalism MedicalKnowledge PatientCare

TheR5willbeabletoefficientlyexecutetheevaluationofmostpatientswithoutmajor changesbeingsuggestedbysupervisingfaculty.

Demonstrateacommandofrelevantcurrent literatureandbeabletoapplyitinthe developmentofanevaluationand(surgicaland/ornon surgical)treatmentplanforthe fullspectrumofOTO/HNSproblemssuchas:

o Headandneckmalignancy

o Complicatedsinonasaldisease

o Complexfacialtrauma

o Complexoto-neurotologiccomplaints

o Structuralandfunctionalvoice/swallowingdisorders

o Thyroidandparathyroiddisorders

DemonstrateconfidenceandcompetenceinthemanagementofOTO/HNSemergencies, alongwiththeskillsneededtoeffectivelyleadthepatientcareteam.

MedicalKnowledge PatientCare

MedicalKnowledge PatientCare Practice BasedLearningandImprovement

Demonstratetheabilitytothinkaheadandcontingencyplantoavoiderrorscausedby lackofequipment,lackofstaff,orlackof appropriateattendingorspecialtyback up,and tocommunicateeffectivelywhileleadingthepatient-careteam.

PatientCare MedicalKnowledge

Professionalism

InterpersonalandCommunicationSkills

Systems BasedPractice

MedicalKnowledge

InterpersonalandCommunicationSkills

Professionalism

Recognizeandanticipate complicationssuchasairwaycompromise,hemorrhage, hematoma,infection,CSFleak,andfistula.

Developandexecuteatreatmentplantomanagesuchcomplications,whiletaking responsibilityasappropriate,andusing suchexperiencestoimprovepatientcare.

Beabletoapplyinformationgainedfromradiographicstudiesintheassessmentofhead andnecklesions,congenitalanomalies,paranasalsinuspathologyandtemporalbone pathology,andunderstandtheappropriateuse,overuse,andlimitationofthesestudies.

Demonstratecompetenceintheinterpretationofthefullrangeofaudiologicstudies includingABR,Enog,andOAEs.

Beabletosuccessfullytransitionfromsupervisionbyfacultytoprimarydecision-making withfacultyoversight.

PatientCare Medicalknowledge

PatientCare MedicalKnowledge Professionalism Practice BasedLearningandImprovement

Systems BasedPractice MedicalKnowledge PatientCare

MedicalKnowledge

Professionalism MedicalKnowledge PatientCare

InterpersonalandCommunicationSkills Supervisepresentationof complicationsontheserviceatmonthlyQualityImprovement conference,includingreviewofrelevantliterature.

Takeprimaryresponsibilityforco-directingmonthlypathologyandradiologyteaching conferenceswiththePathologyandRadiologyDepartments.

InterpersonalandCommunicationSkills Practice BasedLearningandImprovement MedicalKnowledge

Developtheresidentcallschedule.

Demonstratecompetenceandorganizationalskills indirectingtheresidentteaminthe dailymanagementofin-housepatientsandORactivities.

InterpersonalandCommunicationSkills

PatientCare Professionalism

Interpersonaland CommunicationSkills

Demonstrateabilityandcommitmentintheday-to-dayinformalteachingandmentoring ofstudentsandjuniorresidents.

Beabletocompetentlysupervise/assistjunior residentsperformingcommonOTO/HNS surgicalprocedures.

InterpersonalandCommunicationSkills MedicalKnowledge

InterpersonalandCommunicationSkills MedicalKnowledge

Successfullydemonstrateexcellentinterpersonalskills,effectivelysettingthetonefor othermembersoftheresidentteam,clinicalandnon-clinicalstaff.

DemonstratecompetenceinOHNS coding,compliance,documentationand confidentialityissues.

Demonstrateahigh levelofempathyand'culturalcompetence'regardingthosefactors thatconspiretopreventpatientsfromreceivingoptimal healthcare(lackof transportation,languagebarriers,socioeconomicstatus,culturaldifferences,education level,familysupport,etc.),andanunderstandingofresourcesthatcanbeutilizedto improvecareinthesesituations

Demonstrateahighdegreeofself-knowledge,includingpersonalstrengthsand weaknesses,includingtheabilitytoexpandmedicalknowledgethroughliteraturereview, tobeappropriatelyself-critical,andtorequestassistanceand/orconsultationasneeded.

Goal#2: Beabletosafelyandefficientlyperformadvancedotolaryngologyprocedures

InterpersonalandCommunicationSkills

Professionalism

Professionalism Systems-BasedPractice

PatientCare

InterpersonalandCommunicationSkills

Professionalism Systems BasedPractice

Professionalism

Practice basedLearningandImprovement

ResidentObjectives: ACGMECompetencyGoals

Beabletocompetentlyandefficientlyperformadvancedotolaryngologyprocedureswith attendingsupervisionsuchas: PatientCare

o Laryngology

• Laryngoplasty

o Otology/Neurotology

• Tympanomastoidectomy

• Ossicularchainreconstruction

• Stapedotomy

o HeadandNeck

• Partialmaxillectomy

• Modifiedradicalneckdissection

• Compositeresection

• Totalorsuperficialparotidectomy

• Surgicalmanagementofaggressivethyroidmalignancy

• Parathyroidectomy

o Rhinology

• Revisionendoscopicsinussurgery

• Orbitaldecompression

• RepairofCSFleaks

o

FacialPlasticandReconstructiveSurgery

• Complexfacialtrauma,suchasLeFortfractures,naso orbital ethmoidfractures, andcomminutedmandibleandmidfacefractures

• Functionalrhinoplasty

• Repairofpost traumaticandpost ablativedefects

Goal#3: Develop systems-basedunderstandingofotolaryngologypractice

ResidentObjectives:

Attendmonthlystaffmeeting

Demonstratecompetenceincorrectlycodingsurgicalprocedures,consultations,and outpatientvisits(CPTandICD 10).

Demonstratecompetenceinappropriatelydocumentingpatientcaretosupportcoding levelsandtocomplywithinsurancepayorregulations(e.g.Medicare).

Demonstratesenseofempathyregardingthebarriersthatconspiretopreventpatients fromreceivingoptimalhealthcare(lackoftransportation,languagebarriers, socioeconomicstatus,culturaldifferences,educationlevel,familysupport,etc.)

Continuetodevelopanunderstandingofone'sownabilitiesandlimitations,anda commitmenttolife longlearningand improvement,throughactivitiessuchascase presentationatMorbidityandMortalityconference,includingdirectedliteraturereview anddiscussionofsystemsimprovementsasappropriate.

ACGMECompetencyGoals

Systems basedpractice

Systems BasedPractice Professionalism

Systems BasedPractice Professionalism

PatientCare InterpersonalandCommunicationSkills Professionalism

Practice-BasedLearningandImprovement Professionalism

Systems-BasedPractice

StanfordHealthCareandLucilePackardChildren’sHospitalNightFloatRotation

RotationSpecifics:

1. NightfloatisonSunday-Thursdaynightsfrom6pmto6am.

2. Allcallisin-house.

3. Thenightfloatresidentwillseeallconsultsandtakealloutsidecallswhichcomeinafter5pm;betheoperativeresidentonanycases whichstartafter8:00pmandwillbegintakingthefloorcallsoncethehand-offfromthatteamhasoccurred.

4. Beginningat7:30pmthenightfloatresidentwilltakeoverinanyrunningORs.

Goal1. Consults. Knowhowtoevaluateandtreatinpatientandemergencydepartmentconsultpatients.

ResidentObjectives: ACGMECompetencyGoals

Betheinitialcontactresidentforallconsultsat SHCandLPCHservicesincludingthe emergencydepartment.

PatientCare MedicalKnowledge

InterpersonalandCommunicationSkills Systems BasedPractice

Performinitialevaluationofallconsultpatients. PatientCare MedicalKnowledge

BefamiliarwiththeEPICmedicalrecordsystemsandbeabletoaccessinformation appropriately. Understandtheimportanceofconfidentialityinpatientmedicalrecords. PatientCare Professionalism Systems BasedPractice

Consistentlydemonstratecourtesywheninteractingwithclinicalandnon clinicalstaff members.

Performaliteraturesearchtolearn moreaboutunusualpatientproblems.

Createacompleteandcoherentconsultationnoteinatimelyfashion.

InterpersonalandCommunicationSkills Professionalism

MedicalKnowledge Practice BasedLearningand Improvement

InterpersonalandCommunicationSkills Professionalism

Utilizetranslationservicestocommunicatewithnon Englishspeakingpatientsasneeded.

InterpersonalandCommunicationSkills

Systems BasedPractice Professionalism

Demonstrateeffectivetime managementskills. Practice BasedLearningand Improvement

Follow uponconsultpatientsasneeded. PatientCare Systems-BasedPractice Professionalism

Goal2. Hand-offs. Knowhowtoreceiveandgivehand-offs.

ResidentObjectives: ACGMECompetencyGoals

Receiveandgive hand-offsinathoroughandefficientmanner. PatientCare InterpersonalandCommunicationSkills Professionalism

Demonstrateeffectivenessinfollowingupallto doitemscommunicatedthroughthehand offprocess. PatientCare

Goal3.Patientphonecalls. Knowhowtoappropriatelycommunicatewithpatientsviathephone.

ResidentObjectives: ACGMECompetencyGoals

Beabletoobtainanappropriatehistoryfrompatientswhocallinthroughthehospital operators. PatientCare InterpersonalandCommunicationSkills

Beabletodirectoutsidepatientsappropriately. PatientCare InterpersonalandCommunicationSkills

Beabletoappropriatelydocumentpatientphonecallsinthemedicalrecord. PatientCare Systems BasedPractice

Goal4. Operativeexperience. Knowhowtoperformsurgicalproceduresintheafterbusiness-hourssetting.

ResidentObjectives: ACGMECompetencyGoals

Beabletoperformprocedureswhichmustbedoneonanurgentbasisafternormal businesshours. PatientCare

Beabletorapidlylearnapatient’shistoryandstepintoassistinsurgerywhichison going. PatientCare

MedicalKnowledge

OHNSResidentResearchProgram

Introduction:Protectedresearchtimewillbeallottedtoresidentsthroughoutthecourseoftheirtraining.Asthe mainfocalpointofthe researchprogram, R3residentwillhaveonethree monthblockofdedicatedresearchtimetoengageinoneormoreprojects. Inaddition,there willbethree-monthsofhalf-timeresearchtimeduringtheR3year.Eachresidentmusthaveafull-timeStanfordfacultyadvisorandmayhave anadditionaldirectresearchadvisoriftheresearchisperformedoutsidethe Otolaryngologydepartment.Thisrotationisintendedtogivethe residentmaximumflexibilityregardingthesubjectmatteroftheresearchproject. Eachresidentisexpectedtopublishatleastonemanuscript inapeer-reviewedjournalduringtheirresidency.

PGY1/PGY2

DuringthePGY1rotationsonOtolaryngologyandthefirstfewPGY2rotations,theresidentshouldinvestigatedepartmentalprojectsand arrangetomeetwithatleastthreeOtolaryngologyfacultymemberstodiscusspossibleresearchprojectsfortheresearchrotation. ThePGY1 residentshaveafour-weekblockofRadiology/Researchto gettounderstandthebasicsofresearchandto facilitatetheirexplorationof researchopportunities.(SeetheGoalsandObjectivesfor thePGY1Radiology/Researchrotation)

PGY2 Winter

Deadline:January/FebruaryofPGY2year(bepreparedtodiscussatthetimeofsemiannualmeetingwithprogramdirector.)

Afterreviewanddiscussion,theresidentselectsaprojectandwiththehelpoftheiradvisorwritesatwo-pageproposaldetailinghowthe researchblockwillbespent(seebelowfordetails). TheproposalshouldbepreparedforsubmissionfortheAmericanAcademyof Otolaryngology–Head&NeckSurgeryFoundationCOREGrant.

Theresearchproposalshouldconsistof:

▪

Yourfacultyadvisor’sname(mustbeStanfordfull timefaculty).Youmayhaveanadjunctclinicalfacultymemberornon faculty memberasyourdirectresearchadvisor,withtheapprovalofyourfacultyadvisor.Submitbothnames,ifappropriate.

▪

Writtenproposal:

o SpecificAimsand Significance.Whatquestionareyoutryingtoanswerandwhatisthesignificanceofthatquestion?

o Background andLiteratureSearch.Summarizepreviousrelevantworkinthearea;demonstratethatyouhavedoneyour homeworkwithanannotatedbibliographyandexplainhowotherstudieshavebeenlacking.

o Methodology.Howdoyouplantoansweryourquestionorquestions?Howmanyanimalsandwhattypeandhowdidyourchoose thatanimal?Whattypeoflabequipmentwillyoubeusing?Forthosestudiesrequiringaclinicalchartreview,howmanycharts

doyouintendtoreview,where,andhowwillyougetthecharts?Whatproblemsdoyouanticipateandhowdoyouthinkthese canbeovercome?

o Data.Forallproposals,howwillthedatabeanalyzed?Whatstatisticalmethodswillbeused?

o Budget.Thismustbedetailedandappropriatelyjustified.Roughestimatesarenotacceptable.

o Bibliography. PGY3

TheR3willcarryouttheresearchproposalsubmittedduringthePGY2year utilizingthededicatedfull-timeandhalf-timeresearchblocks.

PGY4/5

DuringtheR4year,therewillbeallotted3 6weeksoffull timeresearchtimetocompleteprojectsfromtheR3yearor workonnewprojects.The R5willhaveone5-weekblockoffull-timeresearchorelectivetime. Thegoalsandobjectivesoftheresearchprogramareoutlinedinthefollowingtable.

Competency-basedGoalsandObjectives: PGY3/4/5–Research

Goal1. Beabletoconstructaplanforresearch

ResidentObjectives: ACGMECompetencyGoals

Constructaresearchplanandcreatearesearchproposal (includingSpecificAimsand significance,Backgroundandliteraturesearch,methodology,Dataanalysisplan, Budget,Bibliography). ThisshouldbedoneduringtheR1andR2years.

Completethemandatoryeducationprogramsforinvestigatorsinvolvedinhuman and/oranimalresearch.

CompletetheHumanSubjectsand/orAnimalsubjectsapplicationsandsubmitina timelyfashion.

Systems BasedPractice

Professionalism Systems BasedPractice

Professionalism Systems BasedPractice

Presentyourresearchplantwomonthsbeforetheofficialresearchrotationbegins. InterpersonalandCommunicationSkills

Goal2. Knowhowtocarryoutaresearchproject

ResidentObjectives: ACGMECompetencyGoals

Completethedataacquisitionportionoftheresearchplan.

Demonstrateanabilitytoadapttheresearchplan(“troubleshoot”)basedon unexpectedresultsordifficulties.

Demonstrateanunderstandingofthevariouspersonnelwhocontributetothe researchprocess. Coordinateandperformtheresearchthroughcooperationand respectfulcommunicationwithallmembersoftheresearchteam.

Demonstrateacommitmenttoresearchintegrityincludingthehighestethical standardsingathering, analyzing,andreportingdata.

Goal3.Analysisanddisseminationofresultsofresearchproject

Systems BasedPractice

Professionalism

InterpersonalandCommunicationSkills

InterpersonalandCommunicationSkills

Professionalism

ResidentObjectives: ACGMECompetencyGoals

Demonstrateanabilitytoanalyzethedataobtainedintheresearchstudyand understandthestatisticalmethodsinvolved.

Writeamanuscripttothespecificationsofthejournalproposedforsubmission. Revise themanuscriptbasedoncommentaryfromadvisoryfaculty. Submitthemanuscript forpossiblepublication.

Presenttheresultsofyourresearchattheyear-endresearchsymposium.Talkswillbe 7minuteslongwith3minutesofQ&A. Residentsareexpectedtopresentaprojectat theendoftheir R2,R3,R4andR5years. PresentationattheendoftheR2yearduring theresidentresearchsymposium maybeacasereport.

PresentaresearchprojectattheBayAreaResidentResearchSymposiumonetime duringyourresidency.

Atthecompletionoftherotation,beabletoreflectanddescribeintra/interpersonal andprofessionalchallengesandsuccessesoftheresearchproject.

Systems BasedPractice

Systems-BasedPractice

InterpersonalandCommunicationSkills

InterpersonalandCommunicationSkills

InterpersonalandCommunicationSkills

Practice BasedLearningandImprovement

ChiefResidentMini-FellowshipandElectiveRotations

RotationContactandSchedulingDetails

RotationDirector: C.KwangSung,MD,MS kwangs@stanford.edu

Introduction

TheMini Fellowshiprotationwascreatedin2021 2022asawayforthechiefresidentstotakeadeep diveintoasub specialtyat Stanfordpriortograduationandembarkingonafellowshiporacomprehensiveotolaryngologypractice.Thechiefresidentshould identifyoneortwoattendingsinthechosensub specialtytoserveasmentors.Theresidentshouldplanonspendingasignificant amountoftimeinclinic,aswellastheoperatingroomwiththementor.Therotationisalsoachanceforexposuretosomeofthe ancillaryspecialtiesorservicesthatmighthaveoverlapwiththechosensub specialty.Theresidentshouldplaninadvancetospend timewiththeseservicesforhands onexposure,suchas: • Neurosurgery

Neurology

PlasticSurgery

Ophthalmology

Oncology

RadiationOncology

PalliativeCare

PainMedicine

Gastroenterology

InterventionalPulmonology

Sleep Medicine

Neuroradiology

Pathology

Allergy

Dermatology

Endocrinology

Geriatrics

Dentistry/OralSurgery

• Audiology

• SpeechLanguagePathology

Thechiefresidentelectiverotationisa5 weekblockthatcanbeutilizedforwrappingupresearchprojectsorschedulingformal electiverotations,suchasmedicalmissionsorvisitingrotationsatotherinstitutions. Themaximumamountoftimespentawayfrom campusontheelectiverotationis3weekssincethemaximumtotaltimeawayallowedbythe AmericanBoardofOtolaryngology

Head&NeckSurgeryis6weeksperyear(includingvacation).

ThechiefresidentshouldsubmitawrittenplanfortheMiniFellowshipanduseoftheelective/researchblock atleasttwomonthsprior tothestartoftherotation.

Competency-basedGoalsandObjectives: PGY5–Mini-FellowshipandElective

Goal1. Gainin-depthknowledgeinasub-specialty

ResidentObjectives: ACGMECompetencyGoals

Spendtimeinclinicandtheoperatingroomwithasub specialtymentortoincrease knowledgeandlearnnuancesofthesubjectmatter.

PatientCare MedicalKnowledge Interpersonaland CommunicationSkills Professionalism Systems-BasedPractice

Obtainin personexperiencewithancillaryservicesanddepartmentsrelatedtothechosen sub specialty.

PatientCare MedicalKnowledge

Practice BasedLearningandImprovement

22.Appendices

AppendixA–ConferenceDates

Date Event

Sept.10 14,2022

Feb.11 15,2023

Jan25 27,2023

May3 7,2023

June16,2023

Location AbstractDue

AAO HNSAnnualMeeting Philadelphia,PA 3/15(annually)

AssociationforResearchin Otolaryngology(ARO) Mid WinterMeeting

TriologicalSociety: CombinedSections Meeting

CombinedOtolaryngology SpringMeetings(COSM)

StanfordOHNSResidency Symposium

Orlando,FL 8/2 9/1(annually)

Coronado,CA 7/1 8/1

Boston,MA 7/1 10/15 Stanford,CA 6/1

AppendixB–KeyIndicators

RequiredMinimumNumberofKeyIndicatorProcedures ForGraduatingResidents

Note:Caselogsfor2017programgraduateswillbereviewedforcompliancewithminimum numbersbutnocitationswillbegiven.Residentsgraduatingin2017areexpectedtoachieve therequiredminimumnumbersforallKeyIndicatorProcedures.Achievementoftherequired minimumnumbersisanindicatorofexperiencebutisnotconsideredanindicatorof competence.Programsshouldcontinuetoevaluateproceduralcompetenceinorderto ensurethatgraduatesarecompetenttoenterpracticewithoutdirectsupervision.

Category Procedure Min#

KEYINDICATOR:Head&Neck

Parotidectomy(alltypes) 15 NeckDissection(alltypes) 27 OralCavityExcision 10 Thyroid/Parathyroidectomy 22

KEYINDICATOR: Otology/Audiology Tympanoplasty(alltypes) 17 Mastoidectomy(alltypes) 15 Stapedectomy/Ossiculoplasty 10

KEYINDICATOR:FPRS Rhinoplasty 8 Mandible/MidfaceFractures 12 SkinFlapsandGrafts 20

KEYINDICATOR:General/Peds Airway PediatricandAdult 20 CongenitalNeckMasses 7 Ethmoidectomy 40 Bronchoscopy 22

AppendixC–HandoverEvaluationForm

AppendixD–EvaluationFormofFaculty byResident

AppendixE–EvaluationFormofResidentbyFaculty

AppendixF–EvaluationFormofService/RotationbyResident

AppendixG–ResidentPeerEvaluationForm

AppendixH–EvaluationFormofResidentbyStaff

AppendixI–EvaluationFormofResident byPatient

Milestones

Otolaryngology–HeadandNeck SurgeryMilestones

TheAccreditationCouncilforGraduateMedicalEducation

ImplementationDate:July1,2022 SecondRevision:July2021 FirstRevision:October2013

AppendixK–

FacialTraumaCallPolicy

CraniofacialTrauma&OralMedicine(Dental)CallPolicy StanfordHospital&LucilePackardChildren’sHospital

ThePlasticSurgeryDivisionandOtolaryngology/Head&NeckSurgeryDepartmentprovides StanfordEmergencyDepartmentcallcoverageforMaxillofacial TraumaandDentalrelated problems.

1. Stanford:Otolaryngology(ENT)takescallonevendays. Plasticstakescallonodddays.

a. SCVMC:ENTtakescallonodddays. Plasticstakescallonevendays.

b. VAPA:ENTtakescallonevenmonths. Plasticstakescallonoddmonths.

2. Callswitchesat6amatSHC.

3. Consultisassignedatthetimetheserviceisinitiallypaged(notwhenthepatientarrivesinthe ER/ICUorwhentheresidentanswersthepage).

4. DAYTIMEOralMedicine&MaxillofacialSurgeryConsults:Theservicewillseealldental/OMFS consultsduringnormalbusinesshours(8a 5p,M F);theplastics/ENTresidentshoulddirect referralsandcallstoOMFSduringthistime. Thesmartpagescheduledesignatesthedaytime dentalresident(ifavailable)anddentalattendingwithcontactinformation.

5. NIGHTIMERegardingdentaltrauma(toothluxations/avulsionswithisolatedalveolarbone fractures)orodontogenicinfections: theEDshouldconsultsmartpagetodetermineifadental residentisoncall(dentalresidentisoncallapproximately20%ofthetime.) Ifnodental residentisoncallthenthedesignatedplasticsurgeryorENTresidentshouldbepaged. The back upattendingdentistwillbecontactedbythePlasticSurgery/ENT/Dentaldesignated residentasneededforconsultation.

6. Ontheirdesignatedcalldays,ENTorPlasticswillconsultforcutaneousfacialinfections,TMJ dislocations,andearlacerations.PlasticsmaydefertoENTforfacialinfectionsthataresalivary gland,sinus orear related.

7. Non surgicalinfectionadmissionsmaybeadmittedtoInternalMedicine,andENTorPlastics willfollowasneeded. Ifinternalmedicinewillnotadmitthepatientwithaninfectionofdental orpossibledentaloriginthenthepatientshouldbeadmittedtotheENTorPlasticsurgery servicewhoisonforcraniofacialtrauma/dentalforthatday.

8. ENTistoseealldeepspaceinfections,earhematomas,andtemporalbonetrauma. Ifa temporalbonetraumapatienthasotherfacialtraumaandPlasticsisoncall,thenPlasticsisto addresstheotherfacialtrauma.

9. ENTorPlasticsmayrepaireyelidlacerationsorretaintheoptiontoconsultOphthalmologyfor complexeyelidlacerations.

10. Consultsthatcanbesafelymanagedasanoutpatient:nasalfractures(openorclosed), mandiblefractures(withoutairwayconcern),orbitalfloorfractureswithoutentrapmentor visionchanges,maxillarysinusfractures. Ifpatientsareadmittedforanotherreasonwiththese injuriestheycanbeseenonanon urgentbasisduringtheday.

11. IftheERorthepatienthasaspecificrequestforPlasticSurgeryanditisanEVENday(ENT);orif thereisaspecificrequestforENTonanODDday(plasticsurgery)theresidentwhoiscalledcan respondbyindicatingthattheotherserviceison callforfacialtrauma;Facialplasticsurgeryis includedwithintheENTcallcoverage.HOWEVER,iftheERorpatientspecifically requests/insiststhatthenatureoftheproblemrequiresaspecificservice(eventhoughthat serviceisnotofficiallyoncallthatday)thenyoushouldbeavailabletoseethepatient, regardless.

12. ORBITALFLOORFRACTURES:

a. Days1 10ofmonth:

i. Forisolatedorbitalfloorfractures(ie.,nootherfacialtraumaissues):oculoplastics willbetheleadteamforrepairoforbitfractures noneedtoinvolveplasticsor ENT.

ii. Fororbitalfloorfractureswithotherfacialtrauma: ENT/Plasticswillbethelead teamforotherfacialtraumaandwillcoordinatethecareofthefloorfracturewith Ophthalmology.Inthesecases,Ophthalmologywillberesponsiblefortheorbital floorfractureandanyrepairwillbeperformedasajointcase.

b. Days11 monthend: ENTandplasticswillbetheleadteamonanyorbitfracturewith ophthalmologyhelptocleartheglobe.Ifthereisocularcompromise(globenot cleared)thepatientwillbemanagedbyOphthalmologyandtheorbitalfloorfracture repairwillbedecidedaftertheeyepathologyisappropriatelyaddressed. Orbitalfloor fracturesshouldbereferredtotheENTandplasticsservices,whileOphthalmology consultsareobtainedforvisionandglobeassessmentonly.

Medicine/ENT/FACE/EDInter-ServiceAgreement

Medicine/ENT/FACE/EDInter ServiceAgreement (EffectiveSeptember2019)

Admissions

PatientswithanENT/FACEissuewillbeadmittedtoENT/FACE,UNLESSthepatienthasoneofthe followingmedical conditions, inwhichcasetheywillbeadmittedtoamedicalservice:1,2,3,4,5

1. AcutechestpainorEKG/enzymeevidenceofischemia(includingtroponinaboveupperlimitofnormal) 2. Dyspnea, orsigns/symptomsofpulmonaryedema,or>2 liternewO2requirement(Ifthesesignsorsymptomsare duetoanupperairwayobstructionthenadmittoENT) 3. DecompensatedHeartFailure 4. Uncontrolledarrhythmiaornewarrhythmiawithpersistent/recurrentHR>110 5. DKA 6. Severevalvedisease 7. EF<30%onmostrecentECHO 8. Sepsisoranycomplicatedactiveinfections(e.g.diverticulitisorpneumoniabutnotbronchitisoruncomplicated UTI) InfectionsoftheEar/Mastoid/Nose/Throat/EpiglottiswithsepsiswouldbeadmittedtoENTwithmedicineorID consultifneeded. 9. Acutekidneyinjury 10. Persistent/RecurrentsystolicBP >180ordiastolic>100 11. Persistent/RecurrentsystolicBP <90despiteappropriatefluidchallenge(ICU consultrecommended) 12. Anysignsofactiveinternalbleeding(ExceptepistaxisalonewouldbeadmittedtoENT.Epistaxisduetohematologic disorderwouldbeadmittedtoHeme.) 13. Acutealcoholintoxicationwithsignificantbehavioraldisturbanceoracutealcoholwithdrawal 14. Decompensatedliverdiseaseincludinganyof:hepaticencephalopathy,INR>1.7,newonsetjaundice 15. FocalcentralneurologicchangesincludingstrokeandTIA(admittoneurology) 16. Patientscurrentlyonhospiceorrequiringcomfortcarewho willbemanagednonoperatively 17. Patientsinneedofvulnerableadultorelderabuseevaluation

Consults

SurgicalCo ManagementHospitalist/Nocturnist/MedicineResidentConsultRole

1. IftheSCMhospitalistisconsultedonapatientadmittedtotheotolaryngologyservice, theywillseethepatient within3hours(ifcalledSTATwithin1hour).

2. ForpatientsfollowedbytheSCMhospitalistservice, theSCMhospitalistwillbepageddirectlyregardingmedical issuesfrom8AM 5PM. After5PM,the1st pageformedicalissuesistotheotolaryngologyresidentoncall, whoafter evaluatingthepatientmaythencontacttheon callSCMhospitalist(p24311). TheSCMhospitalistmaycontactthe inhousenocturnist(N1; p12012)toperform bedsideevaluation/treatmentasnecessary. Ifacutemedicalissueswill

1 Admitting medical service is dependent on active medical issues (e.g., decompensated heart failure to CCU/CSU instead of general medicine) and will be determined as per the ED Admissions Grid

2 Patients with an active issue that is more appropriate for a non ENT/FACE/medicine service will be admitted as per the ED Admission Grid (e.g., a patient with facial cellulitis, elevated creatinine, and acute appendicitis would go to general surgery).

3 Uncertainty regarding the appropriate primary admitting team should be resolved through a discussion between the otolaryngology/medicine admitting residents. If after discussion uncertainty persists, it should be resolved through an attending to attending discussion initiated by the service initially called by the ED for admission. (ED Decides on admit service; if a different service is felt to be more appropriate then a transfer to that service can be done per the workflow in this agreement after the admit order)

4 Patients with invasive fungal sinusitis will be admitted to the medicine service with otolaryngology consulting.

5 Patients requiring direct admission after an elective otolaryngology surgery or directly from otolaryngology clinic are subject to this agreement.

requirefrequentmonitoring/treatmentdecisionsthenatransferrequestshouldbeconsidered(seebelow Transfer Requests).

3. TheconsultedSCMhospitalistwillwritedailynotesandordersforevaluationandmanagementofmedicalissues (e.g.,labs,medications,etc.).Noteswillincludefullriskstratificationforintra operativeinterventionandwill recommendadditionalconsultswhenappropriate.

4. Fornon emergentmedicalissuesthatdevelopovernight(5pm 7am) inpatientsknownto theSCMhospitalist,the oncallSCMhospitalistwillcontacttheinhousenocturnisttoperform evaluation/treatment.Ifnon emergentacute medicalissueswillrequire frequentmonitoring/treatmentdecisionsthanatransferrequestshouldbeconsidered (seebelowTransferRequests).

5. Fornon emergentafterhours(5pm 7am) consultsonpatientsnotfollowedbytheSCMhospitalist,the otolaryngologyresident shouldcontacttheon callmedicineconsultresident(p27111)whothenstaffstheconsult withtheon callSCMhospitalist.

6. Foremergentmedicalissues, theICU fellowshouldbecontacteddirectly.

OtolaryngologyConsultRole

1. Ifotolaryngologyisconsultedonapatientadmittedto amedicalservice, theywillseethepatientwithinthatday(if calledSTATforanairway,theywillbeseenimmediately).

2. Otolaryngologyconsultswillwritedailynotesandwillwriterecommendationspertainingtoevaluationof thechief concern, anesthesiaevaluation, ORscheduling,NPOstatus,equipmentorders,PT/OT, perioperativeantibiotics, woundcare, andactivitylevel.

TransferRequests

From OtolaryngologytoaMedicalService

1. Patientsontheotolaryngologyserviceshouldbeconsideredfortransferto amedicalserviceif:

i. Anyoftheabovecriteriausedto determineappropriateadmissionservicedevelop.

ii. Otheractivemedicalissuesthatsupersedeactiveotolaryngologyissuesthatcannotbereasonably/safely managedbytheSCMHospitalist/Nocturnistdevelop.

2. Fornon urgenttransferrequests,thedecisiontorequesttransfershouldbediscussedwiththeconsultedSCM hospitalistpriorto therequest.

3. Theoncallchiefmedicineresidentreviews/approvestransferrequeststo thegeneralmedicineservice.Transfer requeststosub specialtymedicalservices(e.g., generalcardiologyandCCU/CSU) arereviewed/approvedbythe respectiveserviceattending.

From aMedicalServicetoOtolaryngology

1. Patientswhosemedical issuesarestableshouldbeconsideredfortransfertotheotolaryngologyserviceinthepost operativeperiod.

2. Patientsoriginallyadmittedtotheotolaryngologyservice, whoweretransferredtoamedicalserviceforanactive medicalissue,shouldbeconsideredfortransferbacktotheotolaryngologyserviceafterstabilizationofthemedical issue.

3. Patientstransferringfrom themedicineservicetotheotolaryngologyserviceareexpectedtobeverballysignedout totheSCMhospitalistatthetimeoftransfer.

4. ForpatientstransferredfromtheICU overnight,thenocturnist(N1; p12012)shouldbecontactedtophysicallysee thepatientanddeterminestabilityfortransfertootolaryngology.

EmergencyDepartmentRole

1. TheEmergencydepartment(ED)willpage theappropriateadmissionservicebasedontheabovecriteria.

2. TheEDwillnotdeterminetheappropriateadmissionserviceuntilanadequateworkupisobtainedtoassessforthe abovecriteria.

3. TheserviceinitiallypagedbytheEDisresponsibleforadmittingthepatientiftheaboveprocesshasbeenfollowed

C. KwangSung,MD NeeraAhuja,MD

Program Director, Otolaryngology MedicalDirector, GeneralInpatientMedicine Sam Shen,MD

MedicalDirector, AdultEmergencyMedicine

AppendixM–AfterhoursOutpatientMedicalAdvice

• PGY1sarenottotakethistypeofcall.

• Patientsmustreceiveacallbackwithin 30minutesoftheircontactingthe hospital.

• Iftheresidentdoesnotrespondorisunabletohandlethecall promptly (e.g.,scrubbedinsurgery)thenthecallgoestotheattendingphysician oncall(2nd call);afterthattheClinicChief/DivisionChief(3rd call).

• AnymedicaladvicegivenduringthesecallsmustbedocumentedinEPIC.

AppendixN–PagingSystem

EffectiveJune2021

1.SmartPagenowshowsour 3adultfloorpagers(#27082, #27083and#27085)asseparateentries. (Thisshouldhopefullyminimizethenumberoferrantfloorandconsultpagesgoingtothewrong intern.)

2.Basedonresidentfeedback,asecondPedspagernumberhasbeenaddedtodistinguish betweenfloorandconsults.

#25668willremainthepagerIDfor floorissuesandexistingconsults #25670isthenewpagerIDfornewconsultsandSTATairways.Thiswillalsobethepagerthat getsoutpatientphonecalls.

Theovernightresidentshouldtakethetwoconsultpagers:#27087foradultsand#25670for Peds—at6:00pm.ThePedsfloorpager(#25668)canremainassignedtothedayteamuntil theyarereadytosignout.

AppendixO–VerbalOrdersProcessClarificationsforNursesandPhysicians

VerbalOrdersProcessClarificationsforNursesand Physicians(Attendings&Housestaff)

Verbalorders(VOs)haveaninherentdegreeofriskoferror.WhileVOsaresometimesneeded,itis importantthattheprocessbuildinsafeguardstoreducerisk.Optimalverbalorderprocessesare builtonmutualtrustandrespectbetweennursesandphysicians.Acollaborativeprocesswithbuilt inchecksandprecautionsisimportant.

VOsshouldbelimitedtourgentsituationswhereimmediateentryofordersintoEpicisnot feasible.

MD RN

Whentouse:

• Shouldusesoundjudgmentabout whetheritisimpractical(perpolicy)to enterorderintoEpic.(e.g.,ina procedure,tiedupinanemergency,on calloutofhospital.)

• NOTforsimpleconvenience

• ExplainwhyaVOisneeded.

Remainonthephonelongenoughfor“read back”tobecompleted

Epicgeneratedalertsmayresultinpage backtoclarify

VerbalOrdersshouldnotbeusedfor:

• Bloodtransfusions(Typeandholdand MassiveBloodTransfusionProtocolOK)

• NewPCAorder

• Admissionorders

• Ordersets

• Chemotherapeuticagents

Usesafetypracticeswhengivingorder:

• DoubleIDofpatient:name,MR#

• Allpartsofdrugorder(name,form, dose,frequency,route,duration)

• Spelloutnamesofdrugs

• Sayunits,notabbreviations(e.g., milligrams,notmgs)

Willacceptverbalorderingoodfaiththat thereiscompliancewiththeHospital policy/procedure.

Alwaysperforma“readback”

EnterorderintoEpicassoonas possible; clarifyanyEpicgeneratedquestionswith MD

VerbalOrdersshouldnotbeusedfor:

• Bloodtransfusions(Typeandhold,MTP OK)

• New PCAorder

• Admissionorders

• Ordersets

•

Chemotherapeuticagents

Usesafetypracticeswith“read back”:

• DoubleIDofpatient:name,MR#

• Allpartsofdrugorder(name,form, dose,frequency,route,duration)

• Spelloutnamesofdrugs

• Sayunits,notabbreviation(e.g., milligrams,notmgs)

• Saynumberdigits(e.g.,“fifty”becomes “Fifty fivezero”)

• Avoidabbreviations(e.g.,everysix hours notq6hours)

AllVOsmustbecosigned:

• Cosignwithin48hours bestonsame day

• TeammembershouldsignifMDoff service,orotherwisenotavailable

EducationbyMDleaders:

• WhenVOappropriate

• Name&SIDrequired

• Readbackrequired

• Ordersnotallowedasverbal

• Safetypractices

• Cosignw/in48hours;samedaycosignis bestpractice

• Anymemberofteamshouldcosign

• Usecautiontoavoiderrors

Cosigncompliancemanagement:

• Regulardatareportsatspecialtyand individuallevel

• Physicianleaders/programdirectors improvementstrategies

V610/19/18

• Saynumberdigits(e.g.,“fifty”becomes “fifty fivezero”)

• Avoidabbreviations(e.g.,everysixhours notq6hours)

EducationbyRNleaders:

• Name&SIDrequired

• Performreadback

• Ordersnotallowedasverbal

• Safetypractices

• Onlyifimmediateneed

• Usecautiontoavoiderrors

Cosigncompliancemanagement:

• NotRNmanagementresponsibility

(Thistabledoesnotapplytopharmacistswhohavetheirownstandardwork.)

ThesechangeswerecreatedbyajointGME, nursing and physicianworkgroup with pharmacy input:

NeeraAhuja,MD,HospitalMedicineDivisionChief

GretchenBrown,RN,NursingDirector

JanjriDesai,PharmD,AssistDirPharmacy

SharronHampton,RN,NursingDirector

JoeHopkins,MD,AssocCMO

LarryKatznelson,MD,AssocDeanGME

MarcMelcher,MD,GeneralSurgeryResidencyProgramDirector

ElisaNguyen,RN,PCMG1 H1

TopherSharp,MD,CMIO

JulieTisnado,RN,NursingDirector

HirutTruneh,RN,NursingDirector

AppendixP–TemporalBoneLab

AppendixQ–SHCInfectionControl

GoalsandObjectivesforSHCInfectionPreventionandControlDepartment

1.UnderstandandperformnecessaryprecleaningofusedENTendoscopespriortoreprocessingby SterileProcessingDepartment(SPD)ordisposal (https://stanfordhealthcare.policytech.com/dotNet/documents/?docid=13566)

2.FollowStanfordHealthcareInfectionPreventionandControl‘QuickReferenceGuidefor InfectiousDiseasesConditionsandRequiredPrecautions’whenprovidingcaretobothinpatient andambulatorycarepatients (https://stanfordhealthcare.policytech.com/dotNet/documents/?docid=10907)