Goals and Objectives PGY 5: SHC Specialty Service

Goals and Objectives PGY 5: SHCSpecialty Service

Competency-based Goals and Objectives Goal 1. Consults in an adult hospital. Continue to learn about consults requested regarding otologic problems.

Resident Objectives: ACGME Competency Goals Provide backup resident evaluation for all consults from other SHC services and the emergency department. Effectively oversee the discussion of all consults on daily rounds. Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Systems-Based Practice

See consult patients as indicated, and formulate a plan for care. Discuss with attending staff as needed. Oversee the implementation of all clinical plans. Develop a comprehensive understanding of the SHC electronic medical record (Epic) and be able to access information appropriately. Understand the importance of confidentiality in patient medical records. Provide backup and instruction for the other resident team members for its use. Patient Care Medical Knowledge Patient Care Professionalism Systems-Based Practice

Learn to effectively run an inpatient service. Understand how to assign duties appropriate for each resident’s level of training. Provide administrative leadership to cover consults, operative cases, and outpatient clinic.

Establish competency as a leader for teaching on rounds and assigning academic duties to the resident team. Patient Care Medical Knowledge Systems-Based Practice Interpersonal and Communication Skills Medical Knowledge Practice-Based Learning and Improvement

Understand how to oversee all communications between the resident service and other services who share common patients. Learn how to be accurate, professional, and efficient in these interactions. Interpersonal and Communication Skills Professionalism

Establish leadership skills in planning academic meetings, conferences, and schedules. Interpersonal and Communication Skills

Refine effective time-management skills given expected additional time constraints imposed by academic duties. Learn to integrate varied patient care styles from different attendings, and use these to develop personal preferences. Systems-Based Practice Practice-Based Learning and Improvement

Patient Care Systems-Based Practice Professionalism

Lead Skull Base Tumor rounds discussions, understand issues examined, and implement decisions as required. Systems-Based Practice

Goal 2. Chronic Otitis Media. Screen, diagnose and manage patients with symptoms secondary to their chronic ear infections.

Resident Objectives: ACGME Competency Goals Develop a comprehensive understanding of the surgical anatomy, physiology, and pathophysiology of the middle ear and mastoid. The depth of understanding should allow the resident to operate independently in the great majority of chronic ear procedures. Medical Knowledge Take a refined history focused on issues related to recurrent and chronic ear infections, and formulate an optimized plan of care. Patient Care Order and interpret diagnostic tests for assessing otologic disease (e.g. CT and MRI imaging, audiology, tympanometry). Refine efficiency in ordering tests and establish individualized protocols for managing chronic ear disease. Patient Care Medical Knowledge Systems-Based Practice

Be able to assess the ear on exam. Develop mastery of the binocular microscope and otoendoscopy. Understand what findings necessitate operative intervention, and which can be treated in the outpatient clinic. Patient Care

Be able to teach junior residents and medical students the basics of middle ear disease. Patient Care Refine the ability to counsel parents regarding 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. Understand how history and anatomy influence surgical treatment planning. Be able to formulate an independent plan for management of broad categories of middle ear disease. Patient Care

Medical Knowledge

Be able to appropriately manipulate even difficult ears in the clinic with a minimum of patient discomfort. Develop the confidence and reassuring tone to enable this. Interpersonal and Communication Skills Patient Care

Know the management and expected postoperative course of patients who undergo tympanomastoid surgery. Be able to answer the postoperative questions/ concerns, and arrange for appropriate follow-up care. Be able to safely and efficiently perform the majority of tympanomastoid surgery including mastoidectomy, transcanal procedures, ossiculoplasty, etc. Patient Care

Patient Care

Be able to safely work in anatomically challenging middle ears with unconventional anatomy. Patient Care

Be able to take junior residents through the basic steps of tympanomastoid surgery. Patient Care Develop a comprehensive understanding of the natural history of chronic ear disease and its response to treatment. Patient Care

Goal 3. Vertigo. Be able to evaluate and treat peripheral vestibular disease.

Resident Objectives: ACGME competency goals

Refine the understanding of the anatomy, physiology, and pathophysiology of the vestibular system (both peripheral and central), and how it impacts clinical presentation. Medical Knowledge

Be able to take a history related to balance and vertigo. Formulate a directed and practical differential diagnosis. Know how to perform clinical examination of patients with vestibular complaints. Differentiate peripheral from central pathology. Incorporate the interpretation of specialized vestibular tests. Be able to formulate, present and carry out an incremental approach to treating peripheral vestibulopathy. Patient Care Interpersonal and Communication Skills Patient Care

Patient Care Medical Knowledge

Refine the ability to discuss factors involved in vertigo and balance dysfunction with patients and families. Patient Care Interpersonal and Communication Skills Medical Knowledge

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. Discuss medical vs surgical approaches, and formulate an understanding of the role of surgery in these disorders. Be able to interpret the subtleties of vestibular function tests (VNG, VEMP, ECOG, etc), and use them in forming a treatment plan. Patient Care Interpersonal and Communication Skills

Patient Care Medical Knowledge

Be able to discuss care of vertigo patients with providers from other specialties to formulate a care plan involving a number of disciplines. Understand the role of otolaryngologist and other specialists in the management of vestibular disorders. Be familiar with the surgical management of peripheral vestibular disease, and be able to perform the majority of the steps necessary for their successful completion –including selective canal plugging, vestibular neurectomy, and labyrinthectomy. Patient Care Interpersonal and Communication Skills

Patient Care Medical Knowledge Interpersonal and Communication Skills

Goal 4. Hearing Loss Resident Objectives:

ACGME competency goals Be able to obtain a comprehensive hearing loss history and formulate a treatment plan. Patient Care Refine the ability to recognize, describe and categorize acquired and congenital hearing loss. Patient Care Medical Knowledge

Be able to formulate an appropriate and cost-effective work-up for retrocochlear diagnosis, and evaluation of congenital hearing loss. Patient Care Systems-Based Practice

Perform an efficient physical examination for hearing loss, including tuning fork exam, otomicroscopy, cranial nerve exam, pneumo-otoscopy, and know when additional testing is needed. Patient Care

Understand audiometric testing, and how to fully interpret their findings to direct care. Refine the ability to discuss patient data with audiologists to optimize care. Patient Care Medical Knowledge

Understand the basics of hearing aid types, styles, limitations, and the fitting process. Have a basic understanding of how to incorporate hearing aid dispensing into an otolaryngologic practice. Understand the options of surgical correction of conductive hearing loss (stapedectomy, ossiculoplasty) including their indications, limitations, and the relevant anatomic variations that could be encountered intraoperatively. Gain clinical competence in the intraoperative evaluation of ossicular chain mobility, and understand the reconstructive options are available for a given patient. Be able to place the ossicular prostheses. Be able to perform the majority of uncomplicated stapes surgery. Be comfortable in evaluating cochlear implant candidates. Be able to discuss the indications, surgery, postoperative expectations, and need for rehabilitation services. Present the different type of devices available, and understand current areas of clinical research that may implant care. Be able to perform the majority of cochlear implantation.

Goal 5. Neurotology. Diagnose and manage patients with skull base disease

Resident Objectives: Refine the understanding of skull base anatomy to understand the influence of anatomic and pathologic variability on treatment options and patient care. Be able to list the clinical and radiographic presentation of skull base lesions. Refine the ability to obtain a detailed history related to extra-axial neoplasms and other lesions of the internal auditory canal, cerebellopontine angle, temporal bone and posterior fossa. Incorporate relevant patient data into an efficient and optimized care plan. Understand the surgical anatomy, signs, symptoms and clinical diagnosis of lesions of the petrous apex, clivus, and jugular foramen. Refine an understanding for which lesions require immediate treatment, and which do not. Understand the interpretation of radiologic studies used to diagnose lesions of the posterolateral skull base. Be able to combine different modalities in formulating a diagnosis and appropriate treatment plan. Patient Care

Medical Knowledge Patient Care

Patient Care

PatientCare Medical Knowledge Interpersonal and Communication Skills

ACGME Competency Goals Medical Knowledge

Patient Care Interpersonaland Communication Skills

Patient Care Medical Knowledge

Patient Care Medical Knowledge

Be able to effectively order and interpret ancillary tests (e.g. angiography, electrodiagnostic studies, nuclear studies) to evaluate skull base lesions. Discuss the findings effectively with radiologists. Be able to evaluate a patient with vestibular schwannoma and similar lesions, and formulate a reasonable treatment plan based on findings, radiology, and patient preferences. Formulate a work-up and treatment plan for patients with NF-2. Be able to recognize complications of cranial base surgery, including vascular injury, spinal fluid leak, cranial neuropathy, infection, and CNS injury. Recognize the causative factors, and formulate a basic management plan. Understand methods and tehniques to avoid such complications. Refine the ability to collaborate at a high level with a multidisciplinary team to provide comprehensive care for patients with skull base lesions.

Understand the options for benign lesions of the postero-lateral skull base including watchful waiting, focused radiation, and microsurgical resection. Be familiar with treatment planning for stereotactic radiosurgery for uncomplicated lesions of the cranial base. Patient Care

Medical Knowledge Patient Care Medical Knowledge

Patient Care Medical Knowledge

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

Be able to perform the majority of surgical approaches to the cranial base including transmastoid approaches to the jugular foramen, petrous apicectomy, translabyrinthine approaches, and middle fossa craniotomy. Patient Care

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

Resident Objectives: ACGME Competency Goals Be familiar with the indications for all used audiometric tests including pure-tone testing, word recognitions scores, sentence testing, reflex testing, tympanometry). Understand how to use these tests efficiently in the context of clinical findings. Be familiar with interpreting audiometric testing, including their accuracy, reliability, and impact on clinical care. Be able to perform routine tympanograms and audiograms. Patient Care Medical Knowledge

Patient Care Medical Knowledge Patient Care Medical Knowledge

Understand specialized electodiagnostic studies and evokes responses and their indications (including ABR, ECOG, VEMP, rotational chair, posturography testing, VNG, etc). Understand how they can guide further treatment. Patient Care Medical Knowledge

Goal 7. Facial Nerve

Resident Objectives: Understand the surgical anatomy of the facial nerve and its common disorders, including their natural history, clinical presentation, evaluation and treatment. Be able to find and decompress the intratemporal facial nerve with supervision as clinically indicated. Be able to perform the majority of facial nerve neurorrhaphy, including donor graft harvest. Be comfortable with techniques of facial nerve re-routing.

Goal 8. General Otology

Resident Objectives: Be able to independently manage uncomplicated cutaneous lesions of the external ear canal and pinna. Be able to communicate the treatment options and expectations with the patient. Be able to perform clinic-based otologic procedures including myringotomy, and intratympanic injections. Be familiar with local anesthetic used for outpatient otologic procedures. Be able to discuss the basics of intratympanic treatment, including the procedure, its risks, benefits, and expectations.

Be able to effectively evaluate and treat the majority of patients complaining of tinnitus and the spectrum of other non-surgical otologic complaints. Further refine the care of otalgia, including an understanding of when to involve consultation for non-otologic etiologies and when to consult other specialists (pain service, oral surgery, laryngology, etc). Be able to teach junior residents and medical students in the approach to outpatient otology. ACGME Competency Goals Patient Care Medical Knowledge Patient Care Medical Knowledge

ACGME Competency Goals Patient Care Interpersonal and Communication Skills

Patient Care Medical Knowledge

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

Patient Care Interpersonal and Communication Skills

Further 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 improved understanding of one’s own abilities and limitations including awareness of signs of fatigue. Become a more 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

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

Goal 9. Understand the basics of the aesthetic patient consultation

Resident Objectives: Be able to perform a blepharoplasty (upper or lower). ACGME Competency Goals Medical Knowledge Patient Care

Goal 10. Understand the approach to the rhinoplasty patient

Resident Objectives: Be able to perform an effective functional or aesthetic septorhinoplasty.

Goal 11. Understand the approach to the facial trauma patient

Resident Objectives: Be able to perform repair of frontal sinus, naso-orbito-ethmoidal, maxillary, orbital, and mandibular fractures.

Goal 12. Understand the approach to the facial trauma patient

Resident Objectives: Be able to perform a canthoplasty and gold weight procedure. ACGME Competency Goals Patient Care Medical Knowledge

ACGME competency goals Patient Care Medical Knowledge

ACGME competency goals Medical Knowledge Patient Care

Goal 13. 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.

Effectively comprehensively manage primary inhouse, post-operative and consult patients with sinonasal disorders with the junior and senior residents.

Know the endoscopic anatomy and pathophysiology of the sinuses, paranasal skullbase, and extended skullbase including pterygopalatine fossa, infratemporal fossa, orbit, sella, lateral sphenoid recess, clivus and anterior skullbase. Perform literature searches to prepare for public presentations on rhinology topics, and effectively present in quality assurance conferences in a professional and composed manner. Understand radiographic nuances of sinonasal disease processes using both CT versus MRI imaging –sinonasal neoplasms, intraorbital pathology, pneumocephalus, suprasellar intracranial disease. Understand the posterior, lateral, inferior, and superior limits of endoscopic approaches to the skullbase Understand fungal sinusitis, including fungal ball versus allergic fungal sinus disease versus invasive fungal sinusitis. Evaluate patients with chronic sinusitis with and without polyposis –and distinguish which patients may require surgery or medical therapy.

Evaluate patients with chronic sinusitis who have received prior surgery. Understand indications for revision surgical procedures versus use of medical therapies. ACGME Competency Goals

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

Medical Knowledge Practice-Based Learning and Improvement Professionalism Medical Knowledge Interpersonal and Communication Skills

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

Perform proper office debridement of the maxillary, ethmoid, sphenoid and frontal sinuses in the immediate post-operative setting with minimal patient discomfort.

Understand the etiology of sinusitis in the setting of immunosuppression, and surgically manage patients with invasive fungal sinus disease. Identify the signs and symptoms of more rare intranasal pathology, such as autoimmune disease (Wegener’s) and granulomatous (Churg-Strauss) disease. Understand and describe complications of endoscopic sinus surgery, including orbital injury, CSF leak, synechiae formation, middle turbinate lateralization and need for revision surgery. Be able to effectively and compassionately counsel patients of these details. Utilize more advanced equipment and instrumentation to access the nasal cavity –including use of 30, 45, and 70 degree endoscopes to access areas of the nasal cavity, use of hand instrumentation and powered instruments such as microdebriders and drills, and endoscopic cautery tools. Perform safe and methodical endoscopic sinus surgery, including skullbase dissection, frontal sinusotomy, modified Lothrop procedure, and revision endoscopic sinus surgery. Understand principles and techniques for performing open skullbase surgery, including frontal sinus obliteration, cranialization, and Reidel procedures. Demonstrate appropriate surgical technique for advanced endoscopic orbital surgery, including endoscopic dacrocystorhinostomy (DCR) and orbital decompression. Work effectively with the Opthalmology service to coordinate patient intraoperatively and on the floors. Understand and appropriately use reconstructive ladders for intranasal and skullbase lesions, including free tissue grafts, pedicled mucosal tissue flaps, pericranial flaps, and free flaps. Perform safe and efficient endoscopic resection of anterior midline skullbase pathology with reconstruction. Work closely and effectively with a neurosurgical service in coordinated surgical efforts when required. Patient Care

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

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

Patient Care Medical Knowledge

Patient Care Medical Knowledge Interpersonal and Communication Skills

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.