Goals and Objectives PGY 5: SHC Scalpel Service

Goals and Objectives PGY 5: SHC Scalpel Service

Rotation Contacts and Scheduling Details

Please coordinate schedules and care with Attending Surgeons from Head and Neck Surgery (Baik, Chen, Divi, Finegersh, Holsinger, Noel, Orloff, Sirjani, Sunwoo)

Note: if there is no O.R. going on (e.g. attending physician is out of town) resident is expected to attend clinic.

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: 3. 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. 4. 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. 5. Communication with faculty regarding night-time contact with patients For serious issues (e.g. should a patient go back to the OR), it is ideal if calls go up the chain of command. R2s on call should call their chief resident to evaluate, who should notify the fellow, and then the attending. The R2 should NOT bypass senior residents and go directly to the attending. This is for teaching purposes. 6. 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. 7. Residents should strike a balance between learning in the clinic and operating room. However, the chief resident should anticipate and plan in advance so that clinics can be covered as much as possible. This may require asking residents from other services to help. There should never be a chief and the R4 gone at the same time. It may be advisable to limit vacation during the months of heavy R4 interviews. 8. 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. 9. Preparation for OR: Discuss case with attending the day before. Read about the case. Know the patient and why the operation is being performed, the labs, etc.

10. 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). 11. The resident is required to attend the Thursday H&N teaching conference (H&N team). At this conference, the chief resident will assign upcoming cases to junior residents. He/she will also participate in this conference by answering faculty questions regarding 12. Resident are required to attend the Thursday H&N teaching conference (H&N team) and tumor board in addition to the regularly scheduled resident education conferences. 13. Chief resident is expected to attend the monthly faculty meeting.

Evaluation and Feedback

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

Competency-based Goals and Objectives Goal 1: Be competent in evaluating and managing head & neck otolaryngology patients.

Resident Objectives: Expand and refine evaluation and management skills of otolaryngology patients. Such knowledge should allow the R5 resident to confidently and independently care for otolaryngology patients with conditions involving head and neck oncology by the end of the year. Expand participation to include a leadership role in teaching conferences facilitating the learning of the junior residents and medical students. Expand knowledge of Otolaryngology literature for diseases and disorders of the larynx and cancers of the head and neck.

Be able to identify clinically suspicious lesions of the head and neck, perform appropriate biopsies and imaging studies to make to make a diagnosis in a cost effective and time efficient manner. ACGME Competency Goals Medical Knowledge Patient Care

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

Be able to acquire appropriate information to stage head and neck cancers, to present cases in the Head and Neck Tumor Board and to determine the best treatment modality or modalities. When presenting the cases in Tumor Board, up to date literature will be used to support treatment decisions. Be able to discuss the treatment options with the patient and make the appropriate consultations (medical oncology, radiation oncology, dentistry, speech pathology, physical therapy, nutrition and/or social work) based on the patient wishes. This will require consideration of the patient’s rights and a sensitivity to cultural, age, gender, and disability issues. Demonstrate competency in performing comprehensive neck ultrasound to assist in diagnosis, surgical planning, and image guided procedures. Be able to recognize common pathologies (thyroid nodules/cysts, malignancy, normal and abnormal lymph nodes, parathyroid adenoma, ranula, thyroglossal duct cyst).

Develop a comprehensive understanding of the common ablative and reconstructive options. Understand the limits of surgical and medical treatment.

Understand the role of adjuvant therapy.

Understand indications for urgent operative decisions, such as a performing a surgical airway and decompressing an expanding neck hematoma Recognize and manage surgical risk-factors.

Administer care for the post-operative oncology patient.

Expand the capacity to recognize and treat post-surgical complications effectively, and learn to recognize preoperative risk factors. Gain a healthy appreciation for the dangers inherent in medical intervention, and learn how to be appropriate in selecting patients for surgery. Medical Knowledge Practice-Based Learning and Improvement Systems-Based Practice Interpersonal and Communication Skills Professionalism Patient Care

Medical Knowledge

Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Practice-Based Learning and Improvement

Assume a leadership role in postoperative care of complications such as salivary fistula, wound infection, hematoma, cerebrospinal fluid leak, airway compromise, and hemorrhage. Teach the junior residents and medical students to manage these complications. Be able to effectively incorporate radiologic studies in assessing patients with head and neck tumors in a cost effective and time efficient manner.

Be able to successfully transition from supervision by faculty to primary decision making with faculty oversight. Supervise presentation of complications on the service at monthly Morbidity and Mortality conference.

Demonstrate competence and organizational skills in directing the resident team in the daily management of in-house patients and OR activities. Demonstrate ability and commitment in the day-to-day informal teaching and mentoring of students and junior residents. Be able to competently supervise/assist junior residents performing common OTO/HNS surgical procedures. Be able to demonstrate excellent interpersonal skills, effectively setting the tone for other members of the resident team, clinical and non-clinical staff.

Goal 2: Be able to safely and efficiently perform advanced head & neck surgical skills.

Resident Objectives: Refine operative skills and gain expertise in advanced surgical procedures of the head and neck, as well as laryngology. The R5 Otolaryngology residents are expected to assume a graduated responsibility in more complex operative cases. Through their rotation they should become comfortable with taking an active role in the technical procedures such as: • Head and Neck Surgery o Neck Dissection o Laryngectomy (total and partial) o Laryngopharyngectomy o Composite resection • Endocrine Surgery Patient Care Practice-Based Learning and Improvement

Patient Care Medical Knowledge Systems-Based Practice Patient Care

Patient Care Practice-Based Learning and Improvement

Practice-Based Learning and Improvement

Practice-Based Learning and Improvement

Practice-Based Learning and Improvement

Professionalism

ACGME Competency Goals Patient Care

o Thyroidectomy o Parathyroidectomy o Central neck dissection • Reconstructive Surgery o Regional flaps for reconstruction o Maxillectomy o Anterior skull base resection o Parotidectomy o Oral cavity cancer resections o Melanoma of the head and neck o Sentinel lymph node biopsy 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. Patient Care Systems-Based Practice Patient Care Systems-Based Practice Professionalism Systems-Based Practice Practice-Based Learning and Improvement

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.