Goals and Objectives PGY 2/3: SHC Specialty Service

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

Goals and Objectives PGY 2/3: SHC Specialty Service

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

Resident Objectives: ACGME Competency Goals Be the initial 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 patients.

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

Perform a literature search to learn more about unusual patient problems. 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

Follow-up on consult patients as needed. Patient Care Systems-Based Practice Professionalism

Goal 2. Nasal cavity and sinuses. Diagnose and manage patients with nasal problems.

Resident Objectives: Be familiar with the EMR at Stanford (EPIC) to confidentially access appropriate patient information, past culture results, pathology reports and past imaging studies. ACGME Competency Goals Patient Care Professionalism Systems-Based Practice

Evaluate consult patients with sinonasal disorders with the senior residents and faculty. Be able to document and communicate recommendations and plan with the primary team in a professional and courteous manner.

Patient Care Medical Knowledge Systems-Based Practice Interpersonal and Communication Skills Know the anatomy, pathophysiology, and development of the nasal cavity and sinuses. Medical Knowledge Perform literature searches to investigate common and rare patient presentations, and to obtain evidence for current practice paradigms in patient care. Medical Knowledge Practice-Based Learning and Improvement Professionalism

Understand principles and utility of CT versus MRI imaging of the sinuses. Understand and describe anatomic variations of the 4 pairs of paranasal sinuses, patterns of uncinate process attachment and sinus drainage patterns. Be able to obtain a detailed history related to the nose and nasal problems related to sinus disease and allergic rhinitis. Perform safe, informative routine office nasal endoscopy with 0 degree and 30 degree rigid endoscopes. Access and understand AAO descriptive guidelines for acute, subacute and chronic sinusitis, and know the major and minor symptoms associated with diagnosis of sinusitis. Medical Knowledge Interpersonal and Communication Skills

Patient Care Interpersonal and Communication Skills Patient Care

Medical Knowledge Systems-Based Practice

Evaluate patients with chronic sinusitis with and without polyposis –and distinguish which patients may require surgery or medical therapy. Patient Care Medical Knowledge Professionalism

Be able to describe and recognize complications of acute sinusitis.

Identify the signs and symptoms and differences between allergic rhinitis and acute/chronic sinusitis.

Patient Care Medical Knowledge Patient Care Medical Knowledge Understand indications for safe intranasal office biopsy. Patient Care Medical Knowledge Be proficient with the evaluation and management algorithms for treating epistaxis. Patient Care Medical Knowledge Understand options for treatment of nasal septal deviation and turbinate hypertrophy. Patient Care Medical Knowledge

Learn the assembly of equipment needed to perform nasal endoscopy, and intraoperative image guidance. Patient Care Medical Knowledge

Complete basic aspects of endoscopic approaches to the nasal cavity –including use of zero-degree and 30 degree endoscopes, safely navigating the nasal cavity with mucosal preserving technique, performing septoplasty, turbinate reduction, maxillary antrostomy, and anterior ethmoidectomy. Patient Care Medical Knowledge

Goal 3. Allergy–Contact Dr. Meng Chen (mengchen@stanford.edu) at least one month prior to your visit.

Resident Objectives: ACGME Competency Goals Proper history/evaluation and assessment of the allergy patient

Knowledge of therapies for the general allergy patient, including medication classes, dosages, side effects, and combination therapies Proper administration of a skin-prick test x 1 Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care

Proper interpretation of a skin prick test, and historic end point titration test interpretation Proper design of an immunotherapy strategy based on prick testing (Each resident will receive instruction in immunotherapy design fromthe allergy team). Medical Knowledge

Medical Knowledge Patient Care

Understanding the goals, principles and practice of ASA desensitization therapy, and how AERD/ASA intolerance differs from classic allergic reactions. Medical Knowledge

Advantages/disadvantages/principles of intradermal vs. sublingual immunotherapy Medical Knowledge Goal 4. Understand the basics of the aesthetic patient consultation Resident Objectives: ACGME Competency Goals Perform initial contact with outpatient facialplastics patient consultation. Patient Care

Understand pathophysiology of aging process. Goal 5. Understand the approach to the rhinoplasty patient Resident Objectives: Perform initial contact with outpatient consultation for nasal obstruction and/or aesthetic rhinoplasty. Understand pathophysiology of nasal obstruction. Goal 6. Understand the approach to the facial trauma patient Resident Objectives: Provide effective specialist consult services to trauma team/ED for facial trauma.

Understand wound healing. Understand concepts of occlusion. Medical Knowledge

ACGME Competency Goals Patient Care

Medical Knowledge

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

Evaluate patients with facial paralysis. Patient Care

Understand pathophysiology of facial paralysis. Medical Knowledge Medical Knowledge

Goal 7. Chronic Otitis Media. Screen, diagnose and manage patients with symptoms secondary to their chronic ear infections

Resident Objectives: Be able to describe the anatomy, physiology, and pathophysiology of the middle ear and mastoid. ACGME Competency Goals Medical Knowledge

Take a directed history focused on issues related to recurrent and chronic ear infections. Patient Care Describe the use of diagnostic tests for assessing otologic disease (e.g. CT and MRI imaging, audiology, tympanometry). Patient Care Medical Knowledge

Be able to assess the external and middle ear on exam, including the use of the binocular microscope. Differentiate middle ear from external ear disease Patient Care

Patient Care

Be able to counsel parents about the pathophysiology of conditions associated with chronic otitis, its risks, and treatment options.

Patient Care Interpersonal and Communication Skills Understand the indications for surgical intervention, its risks and potential complications Patient Care Medical Knowledge Be able to counsel parents about the risks and benefits of tympanomastoid surgery. Professionalism Interpersonal and Communication Skills

Know the perioperative management and expected postoperative course of patients who undergo tympanomastoid surgery. Patient Care

Be able to safely and efficiently perform the approach for tympanomastoid surgery (postauricular incisions, canal incisions, harvesting graft materials). Patient Care

Be comfortable with mastoidectomy techniques ( bony landmarks, use of drill for cortical bone removal, effective use Suction-irrigation system). Be able to discuss the basics of tympanomastoid surgery patients including potential complications and postoperative expectations.

Goal 8. Vertigo. Be able to evaluate and treat peripheral vestibular disease.

Resident Objectives: Be able to describe the anatomy, physiology, and pathophysiology of the peripheral vestibular system. Be able to take a history related to balance and vertigo.

Know how to perform clinical examination of patients with vestibular complaints. Understand treatments available for acute vestibular dysfunction in the clinic and emergency room. Be able to discuss factors involved in vertigo and balance dysfunction with patients and families.

Be able to counsel parents about the various treatment options available for management of Meniere’s disease, paroxysmal positioning vertigo, and vestibular neuronitis, superior semicircular canal dehiscence, etc Be able to interpret the basics of vestibular function tests.

Be able to discuss care of vertigo patients with providers from other specialties to formulate a care plan involving a number of disciplines. Counsel patients and families about compensatory strategies for minimizing risks in chronic vestibulopathy including the role of vestibular rehabilitation and physical therapy.

Goal 9. Hearing Loss

Patient Care

Patient Care Interpersonal and Communication Skills

ACGME Competency Goals Medical Knowledge

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

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

Resident Objectives: Be able to obtain an appropriate hearing loss history. Be able to recognize, describe and categorize acquired and congenital hearing loss.

Know the most common causes of sensorineural vs conductive hearing loss.

Be able to perform and interpret appropriate physical examination for hearing loss, including tuning fork exam, otomicroscopy, cranial nerve exam, pneumo-otoscopy. ACGME Competency Goals Patient Care Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care

Understand the basics of audiometry, and how to interpret common audiometric tests. Patient Care Medical Knowledge

Be able to counsel patients about hearing aids and assistive listening devices.

Understand the basic options involved in the surgical correction of conductive hearing loss (stapedectomy, ossiculoplasty). Patient Care Medical Knowledge Patient Care

Gain basic capacity for evaluating ossicular chain mobility intraoperatively, and gain a foundation for bimanual manipulation of prostheses under the surgical microscope. Be able to discuss the basics of cochlear implantation with patients and families, including the basics of surgery, postoperative expectations, and need for rehabilitation services.

Goal 10. Neurotology. Diagnose and manage patients with skull base disease

Resident Objectives: Know the basic anatomy, physiology, and pathophysiology of the skull base. Be able to obtain a history related to extra-axial neoplasms and other lesions of the internal auditory canal, cerebello-pontine angle, temporal bone and posterior fossa. Understand the basic anatomy, signs, symptoms and clinical diagnosis of lesions of the petrous apex. Patient Care

Patient Care Medical Knowledge Interpersonal and Communication Skills

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

Understand the basics of radiologic studies used to diagnose lesions of the posterolateral skull base. Understand the indications of ancillary tests (e.g. angiography, electrodiagnostic studies) to evaluate skull base lesions. Be able to evaluate a patient with vestibular schwannoma in the clinic, including history, physical examination, audiometric data, and radiologic studies. Be able to describe and recognize complications of cranial base surgery.

Be able to collaborate with a multidisciplinary team to provide comprehensive care for patients with skull base lesions. Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Interpersonal and Communication Skills

Understand the basic management options for benign lesions of the posterio-lateral skull base including watchful waiting, focused radiation, and microsurgical resection.

Patient Care Medical Knowledge

Goal 11. Audiology. Understand the methods available to test the hearing, and how to interpret the tests.

Resident Objectives: ACGME competency goals

Be familiar with the principal methods and indications for various audiometric tests including pure-tone testing, word recognitions scores, reflex testing, tympanometry). Be familiar with the basics of assessing reliability in audiometric testing.

Be able to interpret routine tympanograms and audiograms.

Understand the basics of most specialized electrodiagnostic studies and their indications (including ABR, ECOG, VEMP, rotational chair, posturography testing, VNG, etc). Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge Patient Care Medical Knowledge

Goal 12. Facial nerve. Be able to diagnose and treat common facial nerve problems.

Resident Objectives: ACGME competency goals

Be able to describe the basic anatomy of the facial nerve and its common disorders, including their natural history, clinical presentation, evaluation and treatment. Patient Care Medical Knowledge

Understand the management of acute facial paralysis, especially as it applies to the postoperative patient. Patient Care Medical Knowledge

Goal 13. General Otology

Resident Objectives ACGME competency goals

Be able to obtain an appropriate history regarding external ear disease, including acute and chronic otitis externa and cerumen impaction. Patient Care Interpersonal and Communication Skills

Become comfortable with otoscopic examination and procedures involving the external auditory canal including canal debridement and cerumen removal. Be able to discuss the procedure, risks, benefits, and expectations of myringotomy with aspiration, and myringotomy with tube placement.

Patient Care Medical Knowledge Patient Care Medical Knowledge Interpersonal and Communication Skills Be able to discuss the basics of tinnitus diagnosis and management. Patient Care Medical Knowledge Be able to perform a directed history and physical examination for patients with otalgia. Patient Care Medical Knowledge

Know how to obtain consultation from other related services for patients with otologic disorders. Patient Care Interpersonal and Communication Skills

Develop an understanding of and sensitivity to the impact of cultural, economic and ethnic factors in the doctor-patient relationship and the delivery of otologic care. Professionalism Systems-Based Practice

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. Professionalism

Professionalism Practice-Based Learning and Improvement

Professionalism

Develop an understanding of OHNS coding and compliance issues in otology/ neurotology. Systems-Based Practice