•̀ừư ̀ưAdult hospital rotations of total of 9 months rotation (JGH, MGH, RVH)
•̀ừư ̀ưDuration: During the Second Half of PGY4 (Jan 1- June 30), two rotations of 3 months
̀ư In addition to one rotation of 3 months during the enrichment year as PGY4
•̀ừư ̀ưThe PGY4 residents will be expected to use their knowledge of the basic sciences to gradually expand their clinical repertoire and clinical problem solving skills.
•̀ừư ̀ưTheir technical training is designed to meet the requirements as outlined in the rotational objectives of the ±«ÓăÖ±²¥ Department of Otolaryngology – Head & Neck Surgery Residency Handbook
•̀ừư ̀ưAll of the general otolaryngology clinics, sub-specialty clinics and surgeries are supervised by attending staff.
•̀ừư ̀ưAll pre and post operative care management are fortified
•̀ừư ̀ưRegular informal quizzing as well as structured written and oral examinations serves as part of the evaluation process, using the One45 framework.
•̀ừư ̀ưAll residents must undergo a STASER or STACER evaluation by attending staff person every six months. They are also evaluated by 360 degree inter-professional evaluation (feedback from allied health care personnel, nurses, secretaries)
Medical Expert
1. Operative objectives
a)̀ư In addition to acquiring greater proficiency in the procedures encountered during the first year, development will be acquired in the following skills:
•̀ừư ̀ưSeptal surgery (septoplasty, nasal polypectomy)
•̀ừư ̀ưSinus surgery
•̀ừư ̀ưCervical node biopsy
•̀ừư ̀ưAssistance at major head and neck surgery
•̀ừư ̀ưMicrolaryngeal surgery
b) Some experience of the following procedures with adequate supervision should be obtained near the end of the second year:
•̀ừư ̀ưRhinologic surgery
̀ừừừư òừư ̀ưrhinoplasty
̀ừừừư òừư ̀ưethmoidectomy, functional endoscopic sinus surgery
•̀ừư ̀ưOtologic surgery
̀ừừừư òừư ̀ưmyringoplasty
̀ừừừư òừư ̀ưtympanoplasty
̀ừừừư òừư ̀ưmastoidectomy
•̀ừư ̀ưNeurotologic surgery
̀ừừừư òừư ̀ưintratympanic injections
•̀ừư ̀ưHead and neck surgery
̀ừừừư òừư ̀ưsalivary gland surgery e.g. submandibular gland excision
̀ừừừư òừư ̀ưNeck dissection different types
•̀ừư ̀ưFacial plastics and Reconstructive surgery
̀ừừừư òừư ̀ư Flaps local and locoregional
̀ừừừư òừư ̀ưsplit and full thickness skin graft
•̀ừư ̀ưLaryngnologic procedures
̀ừừừư òừư ̀ưvocal fold injection
̀ừừừư òừư ̀ưlaser laryngeal procedures
̀ừừừư òừư ̀ư medialization
•̀ừư ̀ưGeneral Otolaryngology
̀ừừừư òừư ̀ưrigid upper endoscopy with foreign body extraction
̀ừừừư òừư ̀ưmanagement of obstructive sleep apnea and surgical options
̀ừừừư òừư ̀ưmanagement of head and neck manifestations of systemic disease
̀ừừừư òừư ̀ưcricothyroidotomy
̀ừừừư òừư ̀ưtracheostomy
c) Exposure to the following procedures:
•̀ừư ̀ưOtology
̀ừừừư òừư ̀ưStapedectomy
̀ừừừư òừư ̀ưfacial nerve surgery
̀ừừừư òừư ̀ưlabyrinthine surgery
̀ừừừư òừư ̀ưneurotologic procedures
•̀ừư ̀ưHead and Neck
̀ừừừư òừư ̀ưParotidectomy
̀ừừừư òừư ̀ưcomposite resection maxillectomy
̀ừừừư òừư ̀ưthyroid and parathyroid surgery
̀ừừừư òừư ̀ưZenker’s diverticulum surgery
̀ừừừư òừư ̀ưlaryngectomy
•̀ừư ̀ưFacial Plastic and reconstructive
̀ừừừư òừư ̀ưOtoplasty
̀ừừừư òừư ̀ưface lift
̀ừừừư òừư ̀ưblepharoplasty
2.̀ư Didactic objectives
Active resident participation in academic half and full day seminars, lectures, hospital rounds and journal clubs will increase. Where possible, the residents will be increasing involvement in teaching junior medical staff to include medical students, clinical clerks and junior residents.̀ư The resident will be introduced to the methods of clinical research and ethics in clinical trials.
3. Temporal bone dissection
The resident will complete his program of temporal bone dissection in preparation for the development of his clinical otological skills.̀ư A temporal bone course is given in the fall of every year.
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PGY4 at the JGH- The Expert Role specific objectives
PGY4 at the MGH - The Expert Role specific objectives
PGY4 at the RVH - The Expert Role specific objectives
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Communicator Role
As a communicator the otolaryngology resident should effectively facilitates the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. The resident is thought and evaluated on these issues:
•̀ừư ̀ưDemonstrate effective establishment of therapeutic relationships with patients and their families
•̀ừư ̀ưRecognize unique issues related to head and neck patients, particularly relevant to patients with cancer of the head and neck including end-of-life discussions
•̀ừư ̀ưRecognize unique biopsychosocial issues related to deafness and the deaf community and recognize their unique communication requirements
•̀ừư ̀ưDemonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
•̀ừư ̀ưObtain and synthesize relevant history from patients, their families, and communities
•̀ừư ̀ưPrepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
•̀ừư ̀ưPresent histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
•̀ừư ̀ưRespect diversity and difference, including gender, religion and cultural beliefs on decision-making
•̀ừư ̀ưDiscuss common procedures with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
•̀ừư ̀ưAddress challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
•̀ừư ̀ưParticipate, and present effectively in organized rounds and seminars
The communicator role is evaluated especially on:
•̀ừư ̀ưDemonstrate effective establishment of therapeutic relationships with patients and their families
•̀ừư ̀ưPresent histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
•̀ừư ̀ưObtain and synthesize relevant history from patients, their families, and communities
•̀ừư ̀ưPrepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
•̀ừư ̀ưDiscuss more complex procedures (e.g. tympanoplasty, thyroidectomy) with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
•̀ừư ̀ưPrepare, participate, and present effectively in organized rounds and seminars
•̀ừư ̀ưDemonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
•̀ừư ̀ưRecognize unique issues related to head and neck patients particularly relevant to patients with cancer of the head and neck including end-of-life discussions
•̀ừư ̀ưRespect diversity and difference, including gender, religion and cultural beliefs on decision-making
•̀ừư ̀ưchallenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
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Collaborator Role
As collaborators the otolaryngology residents effectively work within a health care team to achieve optimal patient care. The resident is thought and evaluated on these issues:
•̀ừư ̀ưDemonstrate an understanding of the team structure of an in-patient service ('the resident team') and fulfill his/her role in this structure
•̀ừư ̀ưDemonstrate recognition and respect for the opinions & roles of other team members
•̀ừư ̀ưIdentify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
•̀ừư ̀ưDemonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
•̀ừư ̀ưRecognize the expertise and role of allied health professionals such as speech language pathologists, audiologists, technicians, nurses, and clerical staff
•̀ừư ̀ưRecognize the advantages for optimal patient care provided by an multidisciplinary Head and Neck oncology team
The collaborator role is evaluated especially on:
•̀ừư ̀ưIdentify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
•̀ừư ̀ưDemonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
•̀ừư ̀ưRecognize the expertise and role of allied health professionals
•̀ừư ̀ưRecognize the advantages for optimal patient care provided by a multidisciplinary head and neck oncology program
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Manager Role
As managers the otolaryngology residents are integral participants in health care organizations, making decisions about allocating resources, and contributing to the effectiveness of the health care system. The resident is thought and evaluated on these issues:
•̀ừư ̀ưUtilize resources effectively to balance patient care duties, learning needs, educational / teaching responsibilities & outside activities and personal life
•̀ừư ̀ưAllocate finite health care resources in a wise, equitable, and ethical fashion
•̀ừư ̀ưUtilize information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
•̀ừư ̀ưActively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
•̀ừư ̀ưAccurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
•̀ừư ̀ưUse patient information tools effectively
•̀ừư ̀ưDemonstrate an appreciation of the importance of quality assurance/improvement, such as patient safety initiatives
•̀ừư ̀ưTake care of charts and use head and neck patient database
•̀ừư ̀ưDemonstrate ability to lead a health care team
•̀ừư ̀ưServe in administrative and leadership roles, such as participate effectively in committees and meetings
The manger role is evaluated especially on:
•̀ừư ̀ưDemonstrate ability to lead a health care team
•̀ừư ̀ưUtilize resources effectively to balance patient care duties, learning needs, Educational/teaching responsibilities and outside activities
•̀ừư ̀ưAllocate finite health care resources in a wise, equitable, and ethical fashion
•̀ừư ̀ưUtilize information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
•̀ừư ̀ưDemonstrate an appreciation of the importance of quality assurance/improvement
•̀ừư ̀ưActively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
•̀ừư ̀ưAccurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
•̀ừư ̀ưServe in administrative and leadership roles, such as participate effectively in committees and meetings
Health Advocate Role
As Health Advocate the otolaryngology residents responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. The resident is thought and evaluated on these issues:
•̀ừư ̀ưRecognize and respond to opportunities for advocacy within Otolaryngology, both for your patients as well as for the community in which we practice and populations at large
•̀ừư ̀ưEncourage behaviors that promote hearing protection and conservation at work and at home
•̀ừư ̀ưFacilitate patients' access to local and national resources available for the hearing impaired
•̀ừư ̀ưEncourage behaviors that reduce/eliminate risk factors for the development of head & neck cancer (e.g., tobacco, alcohol, UVA/UVB sun exposure)
The health advocate role is evaluated especially on:
•̀ừư ̀ưRecognize and respond to opportunities for advocacy within Otolaryngology, both for your patients as well as for the community in which we practice
•̀ừư ̀ưDemonstrate familiarity with important determinants of health relevant to Otology such as environmental noise exposure
•̀ừư ̀ưEncourage behaviors that promote hearing protection and conservation at work and at home
•̀ừư ̀ưFacilitate patients' access to local and national resources available for the hearing impaired
•̀ừư ̀ưEncourage behaviors that reduce/eliminate risk factors for the development of head and neck cancer (e.g.: tobacco, alcohol, UVA/UVB sun exposure)
Scholar Role
As Scholars the otolaryngology residents demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge. The resident is thought and evaluated on these issues:
•̀ừư ̀ưActively participate in the teaching of medical students (didactic, in clinics, and on Wards / in OR
•̀ừư ̀ưFacilitate learning in patients and other health professionals
•̀ừư ̀ưActively participate in preparation and presentation of weekly hospital and grand rounds
•̀ừư ̀ưDemonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
•̀ừư ̀ưDevelop, implement, and monitor a personal educational strategy and seek guidance for this educational strategy as appropriate
•̀ừư ̀ưContribute to the development of new knowledge through participation in clinical or basic research studies
•̀ừư ̀ưDemonstrate commitment to evidence based standards for care of common problems in Otolaryngology
•̀ừư ̀ưDemonstrate the evolving commitment to, and the ability to practice, life-long learning
The scholar role is evaluated especially on:
•̀ừư ̀ưActively participate in the teaching of medical students (didactic, in clinics, and on wards/in OR)
•̀ừư ̀ưFacilitate learning in patients and other health professionals
•̀ừư ̀ưActively participate in preparation and presentation of weekly hospital and Grand Rounds
•̀ừư ̀ưDemonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
•̀ừư ̀ưPractice the skill of self-assessment
•̀ừư ̀ưDevelop, implement, and monitor a personal Educational strategy and seek guidance for this Educational strategy as appropriate
•̀ừư ̀ưDemonstrate the evolving commitment to, and the ability to practice, life-long learning
•̀ừư ̀ưContribute to the development of new knowledge through participation in clinical or basic research studies
•̀ừư ̀ưDemonstrate commitment to evidence based standards for care of common problems in Otolaryngology
•̀ừư ̀ưActively participate in weekly academic rounds series including advance preparation for the topic(s)
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Professional Role
•̀ừư ̀ưAs professionals the otolaryngology residents are committed to the health and well-being of individual s and society through ethical practice, profession-led regulation, and high personal standards of behavior. The resident is thought and evaluated on these issues:
•̀ừư ̀ưDeliver highest quality care with integrity, honesty, and compassion
•̀ừư ̀ưExhibit appropriate professional and interpersonal behaviors
•̀ừư ̀ưPractice medicine and Otolaryngology in an ethically responsible manner
•̀ừư ̀ưRecognize limitations and seek assistance as necessary
•̀ừư ̀ưSeek out and reflect on constructive criticism of performance
•̀ừư ̀ưEndeavour to develop an appropriate balance between personal and professional life to promote personal physical and mental health/well-being as an essential to effective, life-long practice
•̀ừư ̀ưDemonstrate a commitment to their patients, profession and society through participation in profession-led regulation, e.g. recognize and respond to others unprofessional behavior in practice, understand the legal and ethical codes of practice
The Professional role is evaluated especially on:
•̀ừư ̀ưDeliver highest quality care with integrity, honesty, and compassion
•̀ừư ̀ưExhibit appropriate professional and interpersonal behaviors
•̀ừư ̀ưPractice medicine and Otolaryngology in an ethically responsible manner
•̀ừư ̀ưRecognize limitations and seek assistance as necessary
•̀ừư ̀ưSeek out and reflect on constructive criticism of performance
•̀ừư ̀ưEndeavor to develop an appropriate balance between personal and professional life to promote personal physical and mental health/well-being as an essential to effective, life-long practice
•̀ừư ̀ưDemonstrate a commitment to their patients, profession and society through participation in profession-led regulation (e.g.: recognize and respond to other unprofessional behavior in practice, understand the legal and ethical codes of practice
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