Goals and Objectives PGY 2/3: PEDIATRIC Otolaryngology

Create a complete and coherent consultation note and dictate it in a timely fashion. This objective applies to all patients seen in the hospital setting as well as the outpatient setting. Utilize translation services to communicate with non-English speaking patients as needed.

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

Interpersonal and Communication Skills Professionalism

Interpersonal and Communication Skills Professionalism Systems-Based Practice Practice-Based Learning and Improvement

Begin to acquire the following surgical skills: Suturing and knot tying techniques. Patient Care Microscope set up. Cerumen removal. Tonsillectomy and Adenoidectomy steps. Myringotomy and tube placement steps.

Goal 2. Pediatric Otolaryngology Clinics. Learn the common pediatric otolaryngology disorders seen in pediatric otolaryngology clinics and how to evaluate these patients.

Resident Objectives: ACGME Competency Goals Learn how to evaluate a child with sleep-disordered breathing. Patient Care Learn how to evaluate a child with recurrent ear infections. Medical Knowledge Practice pneumatic otoscopy. Interpersonal and Communication Skills Learn how to evaluate a pediatric neck mass, particularly congenital neck masses. Patient Care Medical Knowledge

Goals and Objectives PGY 2/3: PEDIATRIC Otolaryngology

Competency-based Goals and Objectives Goal 1. Consults in a pediatric hospital. Learn about the most common consults requested from other medical and surgical services regarding otolaryngology problems in children.

Resident Objectives: ACGME Competency Goals

Be the initial contact person for all consults from other LPCH services and the emergency department.

Perform initial evaluation of all consult patients.

Be familiar with the LPCH electronic 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.

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. Utilize translation services to communicate with non-English speaking patients as needed.

Demonstrate effective time-management skills. Patient Care Medical Knowledge Interpersonal and Communication Skills Systems-Based Practice Patient Care Medical Knowledge Patient Care Professionalism Systems-Based Practice Patient Care Medical Knowledge Systems-Based Practice Interpersonal and Communication Skills Professionalism Medical Knowledge Practice-Based Learning and Improvement

Interpersonal and Communication Skills Professionalism Interpersonal and Communication Skills Systems-Based Practice Professionalism Practice-Based Learning and Improvement

Follow-up on consult patients as needed.

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

Goal 2. Tonsillar and Adenoidal Hypertrophy. Screen, diagnose and manage patients with symptoms secondary to their tonsils and adenoids

Resident Objectives: ACGME Competency Goals

Be able to describe the anatomy, physiology, and pathophysiology of the tonsils/adenoids/eustachian tube. Medical Knowledge

Take a sleep history with focused questions that assist in the diagnosis of sleep apnea. Patient Care Interpersonal and Communication Skills

Describe the use of diagnostic tests for assessing tonsils and adenoids (e.g. airway films, sleep studies, nasal endoscopy). Patient Care Medical Knowledge

Be able on physical examination to assess obstruction by tonsils, adenoids, turbinates and nasal septum. Describe how to identify a submucous cleft palate. Patient Care

Patient Care

Be able to counsel parents about the pathophysiology of conditions associated with tonsillar and adenoidal hypertrophy, tonsillitis and adenoiditis. Patient Care Interpersonal and Communication Skills

Understand the indications for tonsillectomy and/or adenoidectomy and alternative therapies. Be able to counsel parents about the risks and benefits of tonsillectomy and/or adenoidectomy. Patient Care Medical Knowledge Professionalism Interpersonal and Communication Skills

Know the perioperative management and expected postoperative course of patients who undergo tonsillectomy and adenoidectomy. Be able to safely and efficiently perform an adenoidectomy using the following techniques: microdebrider, coblation, curette. Patient Care Medical Knowledge Patient Care

Be able to safely and efficiently perform a tonsillectomy using the following techniques: cold snare, electrocautery, microdebrider, coblation. Be able to discuss the treatment of and provide care to patients with complications of a T&A procedure.

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

Resident Objectives: Be able to describe the anatomy, physiology, and pathophysiology of the ear and eustachian tube. Be able to take a history related to the ears and hearing. Patient Care

Patient Care Interpersonal and Communication Skills

ACGME Competency Goals Medical Knowledge

Patient Care

Interpersonal and Communication Skills

Know how to perform microscopic otoscopy and pneumatic otoscopy. Understand the available treatments for acute otitis media and chronic serous otitis media. Be able to discuss the indications, risks, benefits,and alternatives to tympanostomy tube placement.

Be able to counsel parents about the risks and benefits of tympanostomy tube placement. Be able to safely and efficiently place tympanostomy tubes. Be able to discuss and treat complications from tympanostomy tube placement. Counsel patients and families about preventing noise exposure and hearing loss in the well child/adolescent setting (e.g. avoiding music and sounds that lead to high frequency hearing loss, wearing ear protectors for noisy tasks.)

Goal 4. Airway. Be able to evaluate children with breathing problems.

Resident Objectives: Be able to obtain an appropriate airway history.

Be able to recognize, describe and categorize stridor in children.

Know the most common causes of stridor in children.

Be able to perform and interpret flexible laryngoscopy in a child. Know the most common cause of stridor and weak voice in a child who has undergone cardiac surgery, and the procedures associated. Be able to assemble the equipment needed to perform a laryngoscopy, bronchoscopy and esophagoscopy. Begin to know how to perform a direct laryngoscopy and bronchoscopy in a child. Discuss routine care of a tracheostomy and describe how to recognize tracheostomy obstruction or decannulation. Patient Care Patient Care Medical Knowledge Patient Care Interpersonal and Communication Skills Medical Knowledge Patient Care Interpersonal and Communication Skills Patient Care Patient Care Patient Care Medical Knowledge Interpersonal and Communication Skills

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

Patient Care Patient Care

Understand and be able to describe to parents the risks of a tracheotomy in a child. Patient Care

Medical Knowledge Interpersonal and Communication Skills

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

Resident Objectives: Know the anatomy, physiology, and pathophysiology of the nose in children. Be able to obtain a history related to the nose and nasal problems.

Understand the signs, symptoms and differences between chronic adenoiditis and sinusitis in children. Understand the etiology, presentation, diagnosis and therapy of sinusitis in children with cystic fibrosis. Understand and be able to recommend and interpret ancillary tests (e.g. plain films, CT scans) to evaluate nasal problems in children. ACGME Competency Goals Medical Knowledge Patient Care Interpersonal and Communication Skills Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge

Be able to evaluate a neonate with nasal obstruction, and understand the possible causes of neonatal nasal obstruction. Be able to describe and recognize complications of acute sinusitis in children. Patient Care Medical Knowledge Patient Care Medical Knowledge

Identify the signs and symptoms of allergic rhinitis. Patient Care Medical Knowledge

Be able to describe and compare pharmacologic options for treatment of acute and chronic adenoiditis, and sinusitis, and allergic and nonallergic rhinitis.

Patient Care Medical Knowledge

Goal 6. Pediatric Audiology. Understand the methods available to test the hearing in children, and how to interpret the tests.

Resident Objectives: ACGME Competency Goals Be familiar with the principal methods for screening the hearing of a newborn (automated auditory brainstem response, Otoacoustic emissions). Patient Care Medical Knowledge Know the age-appropriate way to behaviorally test the hearing of infants and children. Patient Care Medical Knowledge

Be able to interpret routine tympanograms and audiograms. Patient Care Medical Knowledge

Describe general principles about interventions for hearing-impaired children (speech training, sign language, amplification devices, communication boards, cochlear implants). Patient Care Medical Knowledge

Goal 7. Neck. Be able to diagnose and treat common problems which occur in the neck in children.

Resident Objectives: Be able to describe the natural history, clinical presentation, evaluation and treatment options of neck abscesses (retropharyngeal, peritonsillar, parapharyngeal & lymph node) in children. Know the symptoms, signs, and physical examination findings of a thyroglossal duct cyst and branchial cleft cyst. Understand the differential diagnosis of Vascular anomalies in the head and neck in children, just as infantile hemangiomas, lymphatic malformations, and venous malformations. ACGME Competency Goals Patient Care Medical Knowledge

Patient Care Medical Knowledge Patient Care Medical Knowledge

Goal 8. General Pediatric Otolaryngology

Resident Objectives: ACGME Competency Goals Be able to obtain an appropriate history regarding possible foreign body ingestion. Patient Care Interpersonal and Communication Skills

Be able to describe and recognize the signs of symptoms of ear, nose, larynx, esophageal and bronchial foreign bodies. Be able to describe the risks and benefits of foreign body removal from the head and neck.

Be able to describe the signs and symptoms of ankyloglossia and the indication for frenotomy. Be able to counsel patients about the indications, risks, benefits and alternatives to frenotomy.

Be able to safely and efficiently perform a frenotomy. Patient Care Medical Knowledge Patient Care Medical Knowledge Interpersonal and Communication Skills Patient Care Medical Knowledge Patient Care Medical Knowledge Interpersonal and Communication Skills Patient Care Professionalism