Goals and Objectives PGY 4: PEDIATRIC Otolaryngology

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. Systems-Based Practice

Develop an understanding of one’s own abilities and limitations including awareness of signs of fatigue. Continue to participate in the quality improvement process and to follow-up postoperative patients whenever possible.

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. Develop an understanding of OHNS coding and compliance issues in pediatric otolaryngology. Professionalism

Professionalism

Practice-Based Learning and Improvement

Systems-Based Practice

Professionalism Practice-Based Learning and Improvement

Professionalism Systems-Based Practice

Goals and Objectives PGY 4: PEDIATRIC Otolaryngology

Competency-based Goals and Objectives Goal 1. Be able to provide a thorough evaluation and create a treatment plan for consult and otolaryngology patients in a pediatric hospital.

Resident Objectives: ACGME Competency Goals Will provide back-up to the R2 resident for all inpatient and emergency room consults. If R2 resident is not available will be initial contact person for all consults. R4 to work with the R2 in seeing the consults and providing guidance re a treatment plan. In conjunction withthe R2 the R4 will communicate with the fellow and attending physician re the consult. Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Systems-Based Practice

Will lead twice-daily rounds on all inpatients on the otolaryngology service and at least once-daily rounds on all consult patients. Will work together with pediatric OHNS fellow and attending faculty to provide optimum care. Will work to educate the R2 resident and medical students re patient problems. (For example, discussing the details of care with them on morning rounds and encouraging them to read about pertinent patient issues.) Will aid the R2 in performing a literature search to learn more about unusual patient problems. Interpersonal and Communication Skills Systems-Based Practice Medical Knowledge Medical Knowledge Practice-Based Learning and Improvement

Attend at least one “care conference” Systems-Based Practice

Goal 2. Be able to evaluate pediatric patients in the clinic with a wide range of problems.

Resident Objectives: Be able to take a history from more complicated pediatric patients such as those with multiple congenital anomalies and more complex otolaryngology problems such as those with airway obstruction, tracheostomy dependent, veloopharyngeal insufficiency, sensorineural hearing loss. Know the features of common sequences and syndromes seen in pediatric otolaryngology patients such as: Down syndrome, velocardiofacial syndrome, oculoauriculovertebral syndrome, Treacher-Collins syndrome, Crouzon syndrome, Pierre Robin sequence, Usher’s syndrome, Pendred syndrome. Know the common genetic abnormalities found in children with sensorineural hearing loss. Know how to order these tests and interpret them.

Be adept in performing nasal endoscopy and flexible laryngoscopy in neonates.

Be able to initiate an evaluation of a child with hypernasality. Understand the importance of coordinating care with a speech pathologist knowledgeable about velopharyngeal insufficiency. ACGME Competency Goals Medical Knowledge

Medical Knowledge

Medical Knowledge Patient Care Systems-Based Practice Patient Care Medical Knowledge Patient Care Medical Knowledge Systems-Based Practice

Know the surgical and non-surgical options for treatment of velopharyngeal insufficiency. Be able to assist with VPI procedures and to understand the perioperative course.

Know the options for treatment of different vascular anomalies, including surgical and medical management options.

Goal 3. Ears. Be able to evaluate and treat ear disease in children.

Resident Objectives: Know the common presenting symptoms and findings in pediatric patients with a tympanic membrane perforation, severe atelectasis, cholesteatoma, microtia and sensorineural hearing loss. Be able to formulate appropriate treatment plans for all patients with the above clinical conditions. Know the indications for aural habilitation (and rehabilitation) in children with hearing loss. Understand the types of hearing aids available and the difficulties in treating children with these devices. Understandthe indications for bone-anchored hearing aids and cochlear implants in children. Be able to counsel families of children with ear disease regarding appropriate surgical and non-surgical management of their child’s condition.

Be able to perform an underlay tympanoplasty, and simple Mastoidectomy. Be able to assist with canal atresiareconstruction. Understand the expected perioperative course and potential complications of these procedures. Understand the treatment options and treatment timeline for microtia and canal atresia. Be able to assist in rib cartilage harvest and auricular reconstruction.

Goal 4. Be able to evaluate and treat children with breathing problems.

Resident Objectives: Know the common causes and treatments for children who present with a complaint of chronic throat clearing and/or cough. Be able to counsel families regarding these treatments. Medical Knowledge Patient Care Medical Knowledge

ACGME Competency Goals Medical Knowledge

Patient Care Patient Care Interpersonal and Communication Skills Medical Knowledge

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

Patient Care Medical Knowledge

ACGME Competency Goals Patient Care Medical Knowledge Interpersonal and Communication Skills

Be able to formulate a treatment recommendation for children with airway obstruction including children with laryngomalacia, subglottic stenosis, tracheal stenosis, laryngeal cleft, subglottic hemangioma, subglottic cysts. Medical Knowledge

Know the indications, risks and benefits for the following procedures including; microdirect laryngoscopy with excision of lesion, supraglottoplasty, laryngotracheal reconstruction, slide tracheoplasty. Be able to counsel patients regarding these procedures. Be able to discuss the post-operative care for the patient who has undergone a Laryngotracheal reconstruction. Patient Care Medical Knowledge Interpersonal and Communication Skills

Patient Care

Know the most common causes of acute onset of stridor and how to treat them (eg croup, supraglottitis, foreign body aspiration, deep neck abscess.) Patient Care Medical Knowledge

Know the etiology of perioperative laryngospasm in children and how to treat it.

Know the etiology, typical patient, and treatment options for vocal fold dysfunction syndrome (paradoxical vocal fold motion).

Goal 5. Diagnose and manage pediatric patients with nasal problems.

Resident Objectives: Know the presenting symptoms of a child with choanal atresia, nasal dermoid, nasal glioma, nasal encephalocele. Know the different options for repair of choanal atresia and understand the indications, timing, risks and benefits of repair. Understand the causes of chronic sinusitis in children and the indications for endoscopic sinus surgery. Be able to discuss with families the expected perioperative treatment course. Be able to perform endoscopic sunus surgery under direct supervision. Patient Care Medical Knowledge Patient Care Medical Knowledge

ACGME Competency Goals Patient Care Medical Knowledge Patient Care Interpersonal and Communication Skills Patient Care Medical Knowledge Interpersonal and Communication Skills

Be able to set up and utilize the surgical navigation system in the operating room. Patient Care Systems-Based Practice

Goal 6. Neck. Be able to diagnose and treat common problems which occur in the neck in children.

Resident Objectives: ACGME Competency Goals Be able to describe the natural history, clinical presentation, evaluation and treatment options of different types of vascular malformations. Patient Care Medical Knowledge

Know the presentation, work-up, and treatment for congenital torticollis (fibromatosis colli) in young children. Be able to formulate a differential diagnosis for any type of neck mass in a child.

Goal 7. General Pediatric Otolaryngology

Resident Objectives: Be able to perform a microdirect laryngoscopy, and bronchoscopy in a neonate. Be able to perform a routine bronchoscopy with foreign body removal, and esophagoscopy with foreign body removal. Continue to 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. Continue to develop an understanding of one’s own abilities and limitations including awareness of signs of fatigue. Continue to participate in the quality improvement process and to follow-up postoperative patients whenever possible. 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. Continue to develop an understanding of OHNS coding and compliance issues in pediatric otolaryngology. Patient Care Medical Knowledge Patient Care Medical Knowledge

ACGME Competency Goals Patient Care Interpersonal and Communication Skills

Professionalism Systems-Based Practice

Professionalism

Practice-Based Learning and Improvement Professionalism Professionalism Practice-Based Learning and Improvement

Professionalism Systems-Based Practice

HALF-TIME RESEARCH RESIDENT

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