Goals and Objectives PGY 2/3: SHC Headmirror Service

Goals and Objectives PGY 2/3: SHC Headmirror Service

Rotation Contacts and Scheduling Details

Please coordinate schedules and care with Attending Surgeons from Head and Neck Surgery (Capasso, Damrose, Lee, Liu, Megwalu, Sung)

Rotation Specifics

1. Rounding expectations: team is to round together in the morning with the chief resident leading. All members of the team are expected to know what is going on with each patient. On discharge, patients should have a date and time for follow-up. The team should establish this prior to discharge by calling the clinic or communicating with the P.A. The chief resident is expected to be teaching the juniors on rounds. 2. Communication with faculty regarding patients after rounds/weekends: • Communication of some sort is expected each day with each attending. For some, a text message is fine; for others, a phone call. At the start of the service, the chief should establish the best mode of communication with each attending. • When talking with patients, residents should avoid relaying care plans if there is uncertainty. They should tell the patient that they will check with the attending. 3. Communication with faculty regarding night-time contact with patients

For serious issues (e.g. should a patient go back to the OR), it is ideal if calls go up the chain of command. R2s and R3s on call should call their chief resident to evaluate, who should notify the fellow, and then the attending. The R2 or R3 should NOT bypass senior residents and go directly to the attending. This is for teaching purposes. 4. Residents are expected to make entries into medical records for night-time patient contacts. A note should be entered into Epic for each contact with patients. 5. Residents should strike a balance between learning in the clinic and operating room. However, the chief resident should anticipate and plan in advance so that clinics can be covered as much as possible. This may require asking residents from other services to help.It may be advisable to limit vacation during the months of heavy R4 interviews. 6. A brief operative note should be entered within an hour of completion of the surgery by the resident. Dictation of operative reports: within 24 hours.

7. Preparation for OR: Decide a personal goal to achieve in each case. Discuss case with attending the day before. Read about the case. Know the patient and why the operation is being performed, the labs, etc. Seek feedback from faculty by directly asking faculty. 8. When faculty is out of town, continue to communicate with attending daily if available by cell phone. If not, then, communicate with the covering attending or instructor (designated by the attending prior to leaving).

Evaluation and Feedback

The OHNS Faculty on the Headmirror Service (and selected ancillary medical personnel) will complete written evaluations at the end of the rotation. Selected clinic patients will evaluate the residents. Residents will be asked to evaluate each Faculty Member and the rotation. Daily feedback on physical findings, assessment, plan, and surgical technique will occur through clinical interactions.

Competency-based Goals and Objectives Goal 1. Consults in an adult tertiary care hospital. Learn about the most common consults requested from other medical and surgical services regarding laryngeal and general otolaryngology problems in adults.

Resident Objectives: ACGME Competency Goals Be theinitial contact person for all consults from other SHC services and the emergency department. Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Systems-Based Practice

Perform initial evaluation of all consult patientswhen designated and for all laryngology consults. Patient Care Medical Knowledge

Be familiar with the SHCelectronic medical record (EPIC) and be able to access information appropriately. Understand the importance of confidentiality in patient medical records.

Evaluate consult patients with senior resident or fellow and faculty member and communicate recommendations and plan to primary team. Consistently demonstrate courtesy when interacting with clinical and non-clinical staff members.

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

Practice-Based Learning and Improvement

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

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

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

Follow-up on consult patients as needed.

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

Goal 2. Hoarseness. Screen, diagnose and manage patients with symptoms secondary to vocal fold/laryngeal pathology.

Resident Objectives: ACGME Competency Goals

Be able to describe the anatomy, physiology, and pathophysiology of the larynx. Medical Knowledge

Take a history with focused questions that assist in the diagnosis of hoarseness. Patient Care

Describe the use of diagnostic tests for assessing hoarseness (e.g. airway films, sleep studies, laryngeal endoscopy).

Patient Care Medical Knowledge Be able on physical examination to assess abnormalities of the vocal folds (ie, paralysis). Patient Care Describe how to identify a paralyzed vocal fold. Patient Care Be able to counsel patients/parents about the pathophysiology of conditions associated with vocal fold paralysis. Patient Care Interpersonal and Communication Skills

Understand the indications for medialization (e.g., injection, thyroplasty) and alternative therapies. Be able to counsel parents about the risks and benefits of vocal fold medialization. Patient Care Medical Knowledge Professionalism Interpersonal and Communication Skills

Know the perioperative management and expected postoperative course of patients who undergo vocal fold medialization. Be able to safely and efficiently perform a flexible fiberoptic nasolaryngoscopy. Be able to discuss the treatment of and provide care to patients with complications of laryngoscopy.

Goal 3. Swallowing. Be able to evaluate and treat swallowing disorders in adults.

Resident Objectives: Patient Care

Patient Care Patient Care Interpersonal and Communication Skills

ACGME Competency Goals

Be able to describe the anatomy, physiology, and pathophysiology of the pharynx and esophagus. Be able to take a history related to the pharynx and esophagus as regards swallowing problems. Medical Knowledge

Patient Care Interpersonal and Communication Skills

Understand the available treatments for dysphagia. Patient Care Medical Knowledge

Be able to discuss the indications, risks, benefits and alternatives to dilation and to cricopharyngeal myotomy. Patient Care

Be familiar with the endoscopic and open methods of treating Zenker’s diverticulum. Patient Care Medical Knowledge Understand the available bedside and radiographic methods of assessing swallowing. Patient Care Be able to discuss and treat complications from esophagoscopy. Patient Care

Goal 4. Expand ability to perform surgical procedures

Resident Objectives: ACGME Competency Goals Be able to competently and efficiently perform mid-level procedures with attending assistance Patient Care

such as: • Direct laryngoscopy • Flexible and rigid Esophagoscopy. • Injection laryngoplasty • Tonsillectomy • Septoplasty • Turbinate reduction • Tracheostomy

• Panendoscopy • Submandibular gland excision • Excision of congenital cysts • Eustachiantube dilation • Resection of small carcinomas (e.g. tongue, floor of mouth)

Goal 5. Sleep Medicine. Know about normal sleep/wake neurobiology and respiratory physiology

Resident Objectives: ACGME Competency Goals Be familiar with the sleep/wake neural centers and connections associated with normal sleep/wake cycles. Medical Knowledge

Know the sleep stages and architecture. Medical Knowledge Understand options for treatment of nasal septal deviation and turbinate hypertrophy.. Medical Knowledge Patient Care

Goal 6. Know about common sleep disorders and their consequences

Resident Objectives: ACGME Competency Goals

Be able to define and describe the following sleep disorders: Medical Knowledge

Sleep related breathing disorders (SRBD) Patient Care

Insomnia Circadian rhythm sleep disorders Hypersomnias, parasomnias and sleep related movement disorders Insufficient sleep syndrome.

Goal 7. Know how to obtain a sleep history and comprehensive physical examination in patients with sleep complaints

Resident Objectives: ACGME Competency Goals Be able to obtain a sleep history including the ability to identify associated comorbidities from poor sleep: mood and cognitive dysfunction, hypertension, atrial fibrillation, cerebrovascular accidents. Patient Care Interpersonal and Communication Skills Know the Epworth sleepiness scale and be able to administer and interpret the results. Patient Care Interpersonal and Communication Skills Be able to identify craniofacial and soft tissue abnormalities associated with SRBD. Patient Care Interpersonal and Communication Skills

Goal 8. Understand the options for evaluating patients with sleep disorders and how to interpret the appropriate clinical studies.

Resident Objectives: Understand technological tools involved in polysomnographic and home monitoring devices, including EEG, EMG, EOG, EKG, airflow sensors, respiratory effort belts, oximetry/gas monitoring, esophageal pressure, arterial pletismography. Be able on a polysomnogram to identify respiratory events including apneas/hypopneas, RERAs and hypoventilation. Understand the indications and interpretation of the multiple sleep latency test. Understand the use of imaging studies in patients with sleep disorders.

Goal 9. Improve general otolaryngology knowledge

Resident Objectives: Develop competence in the interpretation of head and neck imaging studies through regular review of all patient imaging and attendance at radiology rounds. Learn to set-up and use the facial nerve integrity monitor. Demonstrate competence in the safe and appropriate use of various lasers. Learn the nuances of correctly coding surgical procedures, consultations, and outpatient visits (CPT and ICD-9). Be able to appropriately document patient care to support coding levels and to comply with insurance payor regulations (e.g. Medicare). Develop an understanding of and sensitivity to the impact of cultural, economic and ethnic factors in the doctor-patient relationship and the delivery of healthcare. Develop an understanding of one’s own abilities and limitations including awareness of signs of fatigue. Become an intelligent user of the academic literature in otolaryngology. Demonstrate the ability to apply knowledge of study designs and statistical methods to appraise clinical studies. Perform literature searches as needed to continuously improve the level of medical knowledge. ACGME Competency Goals Medical Knowledge

Medical Knowledge

Medical Knowledge Medical Knowledge

ACGME Competency Goals Patient Care Medical Knowledge Patient Care Patient Care Patient Care Systems-Based Practice Patient Care Systems-Based Practice Professionalism Systems-Based Practice Professionalism

Professionalism

Practice-Based Learning and Improvement

HALF-TIME RESEARCH RESIDENT

• Research Resident must have at least 2.5 days of research time per week on average. • During PGY2/3 or PGY4’s vacation/conference/interview period, Half-time Research Resident usually works as full time.