CONTENTS
____________________________________________________
1. OVERVIEW
The Department of
Otolaryngology-Head and Neck Surgery at the University of Tennessee Health
Science Center (UTHSC) provides comprehensive postgraduate training in the
medical and surgical management of head and neck disorders in a rich
academic environment. The program is structured to include 4 years of
training in Otolaryngology-Head and Neck Surgery following a 1 year general
surgery internship. Currently, the department is approved for a total of 10
residents, such that 2 or 3 candidates are selected on alternate years
through the National Otolaryngology Matching Program.
The educational curriculum is divided into 9
clinical rotations and a block of dedicated research time. Each rotation is
3,4, or 6 months in duration. Rotations performed in the first 2 years
focus on the development of basic skills and fundamental knowledge, with
guidance and supervision provided closely by faculty and senior residents.
Rotations in the final 2 years foster increasing levels of independence with
respect to patient management, the performance of procedures, and
administrative activities. The chief resident year (fourth year of
otolaryngology training) is specifically dedicated to the performance of
advanced procedures and the management of difficult cases. Chief residents
are also expected to teach and supervise more junior residents, with faculty
oversight. Sound clinical judgment, technical skill, and scholarly activity
are developed and encouraged throughout the 4 years of training.
The primary
adult teaching hospitals include Methodist University Hospital, the Regional
Medical Center (“The Med”), Veteran Affairs (VA) Medical Center, and Baptist
Memorial Hospital. Specialized pediatric experience is provided at
LeBonheur Children’s Hospital and St. Jude’s Children’s Research Hospital.
The department is led by Chairman Jerome W. Thompson, MD, MBA. Dr. Thompson
is also the Clinical Director of Otolaryngology-Head and Neck Surgery for
the University of Tennessee Medical Group (UTMG), a multi-disciplinary
practice group affiliated with the UTHSC. The full time teaching staff is
complemented by part time and volunteer faculty members to augment the
clinical and academic experience.
The department sponsors a
comprehensive series of resident education lectures as well as grand
rounds. The didactic curriculum also includes regular patient care
conferences, multi-disciplinary tumor board, morbidity and mortality
conference, journal club, board review forum, and research conference.
____________________________________________________
2. CORE
COMPETENCIES SUMMARY
This is
available from the department upon request.
____________________________________________________
3. ROTATIONS –
MEDICAL AND SURGICAL SKILL OBJECTIVES
General Rotation Schedule
In years with three graduating chief residents:
OTO-Y4 Methodist (4 mo)
Med/Baptist (4 mo) Baptist/Otology (4 mo)
OTO-Y3 Med/Trauma/Plastics (6
mo) VA (6 mo)
OTO-Y2 Pediatric (4 mo)
Research (4 mo) Methodist (4 mo)
OTO-Y1 Med (6 mo)
VA (6 mo)
In years with two graduating chief residents:
OTO-Y4 Methodist (6 mo)
Baptist/Otology (6 mo)
OTO-Y3 Med/Trauma/Plastic (4 mo) VA (4
mo) Med/Baptist (4 mo)
OTO-Y2 Pediatric (6 mo)
Research (4 mo)+Methodist (2 mo)
OTO-Y1 Med (4 mo) VA
(4 mo) Methodist (4 mo)
Note: 6 month blocks may be split into two, nonconsecutive 3 month blocks.
Methodist University Hospital
Methodist University Hospital is a 741 bed adult acute care facility. The
rotation exposes residents to the full spectrum of otolaryngic disorders in
the adult population, including head and neck oncology, trauma, cosmetic
surgery, otology, and sino nasal disease. The experience includes 1) an
attending-supervised resident practice under the direction of Dr. Rakesh
Chandra, and 2) resident involvement in the private cases of adult ENT
faculty. Methodist is also home to the UT Cancer Center. The Methodist
rotation is a chief resident experience (OTO-Y4). During years with three
graduating chiefs, an OTO-Y2 will be assigned to this service. When there
are two graduating chiefs, the service will include an OTO-Y1, plus an
OTO-Y3 for 4 months of the year.
The OTO-Y4 resident must:
General
ü
Competently perform ESS including frontal, posterior ethmoid and sphenoid.
Apply image guided surgery.
ü
Make accurate assessments in the diagnosis of sleep apnea. Order
appropriate testing, and select the optimal management, including the role
of CPAP. Perform sleep apnea surgery including UP3, genioglossus
advancement, and hyoid suspension.
ü
Proficiently respond, evaluate, and manage acute and emergency problems of
the head and neck, including airway obstruction, epistaxis, serious head and
neck infections and surgical complications.
ü
Apply effective medical management for otologic and sinus disease, including
the evaluation and management of allergic etiologies.
ü
Exhibit organization and management skills to manage an inpatient clinical
service and outpatient practice, with faculty oversight.
ü
Supervise, with faculty oversight, the development of skills and knowledge
by the junior resident.
Otology
ü
Diagnose and manage acute and chronic ear disease, including tympanoplasty,
mastoidectomy.
ü
Expertly interpret audiometric and radiographic studies, including ABR, CT,
and MRI. Apply these tests with appropriate indications.
ü
Workup and manage SNHL, including the selection of amplification.
ü
Perform accurate evaluation for balance disorders.
Head and Neck
ü
Accurately perform flexible and rigid endoscopy for workup and staging of
malignancies.
ü
Expertly interpret CT, MRI, and other radiographic evaluations of the head
and neck.
ü
Perform complex head and neck oncologic surgery such as neck dissection,
laryngectomy, composite resection, parapharyngeal space, skull base,
craniofacial resections, thyroidectomy, and salivary gland excision.
ü
Exhibit the ability to make clinical judgments regarding the management of
oncologic problems, with active involvement in the multidisciplinary team
including medical oncologists, radiation oncologists, oral surgeons,
prosthedontists, psychiatrists, and members of other surgical disciplines.
ü
Evaluate and manage thyroid and parathyroid disorders, and participate
effectively with endocrinologist in the evaluation and treatment of patients
with these disorders.
ü
Interpret histologic data, including FNA, for squamous cell carcinoma,
thyroid nodules, masses of the salivary glands, paraganglioma, and other
tumors of the head and neck.
Trauma/Plastic/Reconstructive
ü
Assess and plan treatment for patients seeking cosmetic facial surgery
including rhinoplasty, rhytidectomy, malar/mental augmentation and skin
resurfacing.
ü
Describe the technical aspects of cosmetic surgical techniques and
efficiently assist attending staff in these procedures.
ü
Evaluate and select reconstructive options after resection of head and neck
neoplasms.
ü
Perform local and regional flap reconstruction, as well as skin grafting,
full and split thickness.
The OTO-Y2/Y1 resident must:
General
ü
Efficiently and accurately assess patients in the outpatient clinic,
including history and otolaryngic physical exam, rigid and fiberoptic
endoscopy of the sinonasal tract/pharyx/larynx, and otomicroscopy.
ü
Participate in the hospital-based care of patients on the resident service,
and those admitted by attending staff.
ü
Perform initial assessment of consultation patients, both in the hospital
and in the emergency room, developing differential diagnoses and proposing
treatment plans.
ü
Evaluate and manage of acute and chronic sinusitis, including interpretation
of associated imaging studies, medical/allergy therapy, and postoperative
care.
ü
Competently perform nasal septoplasty, maxillary antrostomy, anterior
ethmoidectomy, turbinate reduction.
ü
Diagnose sleep disordered breathing syndromes, apply and interpret
appropriate diagnostic imaging, and select appropriate management
strategies, including CPAP. Perform general procedures such as
tonsillectomy and UP3, and assist in more complex procedures.
ü
Develop skills in managing emergencies including airway obstruction,
epistaxis, head and neck trauma, and serious head and neck infections. This
includes performance of tracheostomy, abscess drainage, and nasal packing,
anterior and posterior. Know the roles of the emergency department,
radiology, and interventional radiology in the management of these
conditions.
ü
Demonstrate operative skills sufficient to perform, with minimal guidance,
general procedures such as those described above. Become familiar with the
techniques of more complex operations, and serve as an effective operative
assistant.
Otology
ü
Evaluate and manage, both medically and surgically, acute and chronic ear
disease. This includes interpretation of audiometry and CT/MRI. Apply
appropriate indications for these tests.
ü
Workup and manage SNHL, including the selection of amplification.
ü
Explain the differential diagnosis and perform an appropriate workup of
balance disorders.
ü
Competently perform ventilation tube insertion, myringoplasty, cerumen
removal, foreign body removal, and cavity debridement.
Head and Neck
ü
Distinguish benign from malignant from inflammatory lesions based on
physical exam and office endoscopy, and apply appropriate workup and
management algorithms.
ü
Select and interpret appropriate diagnostic imaging for head and neck
neoplasms.
ü
Perform staging panendoscopy. Consolidate this data with that obtained from
clinical and radiographic evaluation to accurately stage malignancies.
ü
Manage patients with head and neck neoplasia in conjunction with members of
a multidisciplinary team.
ü
Manage the endocrinologic aspects of thyroid/parathyroid disease.
ü
Describe the histopathologic features of a lesion or neoplasm; distinguish
benign from malignant tumors. Recognize common head and neck neoplasms such
as squamous cell carcinoma, papillary thyroid carcinoma, pleomorphic
adenoma, and basal cell carcinoma.
Trauma/Plastic/Reconstructive
ü
Describe the principles of aesthetic facial surgery, including facial
analysis, and assist in the surgical procedures being performed in the
private office setting.
ü
Perform a basic trauma evaluation, including application and interpretation
of CT, plain films, and panorex.
ü
Evaluate and select reconstructive options after resection of head and neck
neoplasms.
ü
Perform local flap reconstruction and skin grafting, full and split
thickness.
The Med/Trauma & Plastics
The Regional Medical Center (“The Med”) is a 335 bed urban public hospital
where the full spectrum of otolaryngologic disorders often present in
advanced states. The Med is the only Level I trauma center in this
metropolitan area. Three residents are assigned to this service: one fourth
year or chief (OTO-Y4), one third year (OTO-Y3), and one first year
(OTO-Y1). The chief position will be filled by an OTO-Y3 “acting chief” in
the event that there are only 2 graduating OTO-Y4 residents in a particular
academic year. The rotation has both a trauma service and an
otolaryngology service.
The trauma component is integrated with the Facial Plastic Surgery Clinic,
under the direction of Dr. Phillip Langsdon. The trauma resident (OTO-Y3)
will evaluate and manage all facial trauma at The Med under Dr. Langsdon’s
supervision and will cover cosmetic/reconstructive cases at the Facial
Plastic Surgery Clinic. The otolaryngology service is overseen by Dr.
Francisco Vieira. Residents on the otolaryngology service (OTO-Y4 and
OTO-Y1) will also assist UT faculty in private clinics/cases, including
those performed at Baptist Memorial Hospital. The otolaryngology service
resident(s) will also cover the UT multidisciplinary endocrinology clinic,
focusing on the medical management of thyroid and parathyroid disease.
The OTO-Y4 (or OTO-Y3 acting chief) must:
General
ü
Effectively lead a team of otolaryngology residents managing patients with
disorders of the head and neck. Increasing responsibility will be given
depending on the seniority of the resident (OTO-Y4 or –Y3), at the
discretion and supervision of the faculty.
ü
Proficiently coordinate daily care for inpatients, conducting the MedPlex
clinic, managing the consultation service, and maintaining an organized
operating room schedule at The Med in conjunction with the trauma resident
and attending staff.
ü
Practice cost effective, medically sound, patient management.
ü
Competently perform ESS including frontal, posterior ethmoid, and
sphenoid.
ü
Proficiently respond to acute and emergency problems of the head and neck,
including airway obstruction, epistaxis, serious head and neck infections
and surgical complications.
ü
Apply effective medical management for otologic and sinus disease.
ü
Supervise, with faculty oversight, the development of skills and knowledge
by the junior resident.
Otology
ü
Diagnose and manage acute and chronic ear disease, including tympanoplasty,
mastoidectomy.
ü
Expertly interpret audiometric and radiographic studies, including ABR, CT,
and MRI. Apply these tests with appropriate indications.
ü
Workup and manage SNHL, including the selection of amplification.
ü
Evaluate and manage otosclerosis, including stapedectomy.
Head and Neck
ü
Accurately perform flexible and rigid endoscopy for workup and staging of
malignancies.
ü
Expertly select and interpret CT, MRI, and other radiographic evaluations of
the head and neck.
ü
Interpret histologic data, including FNA, for squamous cell carcinoma,
thyroid nodules, and masses of the salivary glands.
ü
Perform complex head and neck oncologic surgery such as neck dissection,
laryngectomy, composite resection, parapharyngeal space, skull base,
craniofacial resections, thyroidectomy, and salivary gland excision.
ü
Make accurate clinical judgments regarding the management of oncologic
problems, with active involvement in the multidisciplinary team including
medical oncologists, radiation oncologists, oral surgeons, prosthedontists,
psychiatrists, and members of other surgical disciplines.
ü
Diagnose and manage medical aspects of thyroid and parathyroid disorders,
and participate effectively with endocrinologist in the care of these
patients.
ü
Evaluate, manage, and provide follow-up care for late treatment effects in
head and neck oncology patients.
ü
Interpret histologic data, including FNA, for squamous cell carcinoma,
thyroid nodules, masses of the salivary glands, paraganglioma, and other
tumors of the head and neck.
Trauma/Plastic/Reconstructive
ü
Evaluate and select reconstructive options after resection of head and neck
neoplasms.
ü
Participate effectively as a member of the micro vascular reconstructive
team for head and neck defects and have a general knowledge of donor site
options, vascular anastomosis, and flap insetting.
ü
Perform local and regional flap reconstruction, as well as skin grafting,
full and split thickness.
ü
Manage complex trauma patients and participate in the team approach to their
care, in conjunction with the “trauma resident,” as described below.
The OTO-Y3 resident (trauma resident) must:
ü
Participate with members of a
trauma team, each with his/her own specific responsibilities and
capabilities. Describe the nature of injuries associated with head and neck
trauma, including those affecting the C-spine or intracranial contents, and
thorax.
ü
Apply the principals,
techniques, and perioperative care of facial fractures, including those
involving the ZMC, midface/LeForte, mandible, frontal region, orbit,
naso-orbital-ethmoid complex, and nasal bone.
ü
Select and interpret
appropriate radiographic evaluation for the above.
ü
Apply the principals, techniques, and perioperative care of soft tissue
wound repair and scar revision.
ü
Describe and apply the
principles of facial analysis.
ü
Diagnose problems expressed by
the cosmetic surgery patient, select the appropriate techniques for
management, and understand the surgical principals and postoperative care of
these problems.
ü
Apply the principles,
techniques, and perioperative care associated with cosmetic procedures
including blepharoplasty, rhinoplasty, the various forms of rhytidectomy,
injectable and alloplastic implants, hair restoration, and chemical
denervation. Also, competently assist in these procedures.
ü
Describe and apply the
principals, techniques, and care concerning skin resurfacing and the Facial
Skin Care Program using Retin A®, glycolic acid, and skin care creams.
ü
Address the psychosocial needs
of patients undergoing plastic and reconstructive surgery. Apply these
principles in comprehensive patient management.
ü
By the conclusion of this
rotation, the resident must have watched the series of Facial Plastic
Surgery Videos recommended by the American Academy of Facial Plastic and
Reconstructive Surgery (located in Dr. Langsdon’s office).
The OTO-Y1 resident must:
General
ü
Efficiently and accurately assess patients in the outpatient clinic,
including history and otolaryngic physical exam, rigid and fiberoptic
endoscopy of the sinonasal tract/pharyx/larynx, and otomicroscopy.
ü
Participate in the hospital-based care of resident service patients, and
those admitted by attending staff.
ü
Perform initial assessment of consultation patients, both in the hospital
and in the emergency room, developing differential diagnoses and proposing
treatment plans.
ü
Evaluate and manage acute and chronic sinusitis, including interpretation of
associated imaging studies, medical/allergy therapy, and postoperative care.
ü
Competently perform nasal septoplasty, maxillary antrostomy, anterior
ethmoidectomy, turbinate reduction, tonsillectomy, and UP3.
ü
Evaluate and manage emergencies including airway obstruction, epistaxis,
head and neck trauma, and serious head and neck infections. This includes
performance of tracheostomy, abscess drainage, and nasal packing (anterior
and posterior). Participate effectively with members of the emergency
department, radiology, and interventional radiology in the management of
these conditions.
ü
Demonstrate operative skills sufficient to perform, with minimal guidance,
general procedures such as those described above. Become familiar with the
techniques of more complex operations, and serve as an effective operative
assistant.
Otology
ü
Evaluate and manage, both medically and surgically, acute and chronic ear
disease. This includes interpretation of audiometry and CT/MRI. Apply
appropriate indications for these studies.
ü
Workup and manage SNHL, including the selection of amplification.
ü
Competently perform ventilation tube insertion, myringoplasty, cerumen
removal, foreing body removal, and cavity debridement.
Head and Neck
ü
Distinguish benign from malignant from inflammatory lesions based on
physical exam and office endoscopy, and apply appropriate workup and
management algorithms.
ü
Select and interpret appropriate diagnostic imaging for head and neck
neoplasms.
ü
Perform staging panendoscopy. Consolidate this data with that obtained from
clinical and radiographic evaluation to accurately stage malignancies.
ü
Manage patients with head and neck neoplasia in conjunction with members of
a multidisciplinary team.
ü
Describe the histopathologic features of a lesion or neoplasm; distinguish
benign from malignant tumors. Recognize common head and neck neoplasms such
as squamous cell carcinoma, papillary thyroid carcinoma, pleomorphic
adenoma, and basal cell carcinoma.
ü
Competently diagnose and workup thyroid nodules, goiter, and hyper/hypo
functional thyroid states. Assess these diseases via the application of FNA,
ultrasound, and radionuclide imaging. Apply appropriately indicated
laboratory testing. Manage these problems medically, and select the
appropriate surgical procedures.
ü
Diagnose hyperparathyroidism, including the application of indicated
laboratory tests and diagnostic imaging. Manage these problems medically,
and select the appropriate surgical procedures.
Trauma/Plastic/Reconstructive
ü
Perform a basic trauma evaluation, including application and interpretation
of CT, plain films, and panorex.
ü
Become competent in applying arch bars, intermaxiallry fixation, and micro/miniplates.
ü
Evaluate and select reconstructive options after resection of head and neck
neoplasms.
ü
Perform local flap reconstruction and skin grafting, full and split
thickness.
VA Medical Center
The VA Medical Center is a 283 bed facility that provides care to the
typical veteran population, many of whom are males of geriatric age. This
is a broad based clinical experience in general otolaryngology, with some
prevalence of head and neck oncology. The service is overseen by Dr. Hodges
and Dr. Merry Sebelik. Two residents (OTO-Y3 and OTO-Y1) are assigned to
this service.
The OTO-Y3 resident must:
General
ü
Evaluate and manage sinus disease, including medical/allergic aspects and
postoperative care. Competently perform maxillary antrostomy and anterior
ethmoidectomy. Develop progressive experience in frontal and sphenoid
surgery.
ü
Make accurate assessments in the diagnosis of sleep apnea. Order
appropriate testing, and select the optimal management, including the role
of CPAP. Perform sleep apnea surgery including UP3, genioglossus
advancement, and hyoid suspension.
ü
Evaluate and manage laryngeal dysfunction related to aging.
ü
Accurately assess and manage audiovestibular functions related to aging,
including the influence of systemic, neurologic, and cardiovascular disease.
ü
Develop an increasing level of independence, with faculty supervision, to
prepare for the OTO-Y4 chief resident position.
ü
Demonstrate the ability to impart knowledge to junior residents and assist
in their skill development.
Otology
ü
Diagnose and manage acute and chronic ear disease, including tympanoplasty,
mastoidectomy.
ü
Expertly interpret audiometric and radiographic studies, including ABR, CT,
and MRI. Apply these tests with appropriate indications.
ü
Workup and manage SNHL, particularly it affects the aging population.
Select appropriate amplification.
ü
Workup and manage balance disorders, particularly it affects the aging
population. Appreciate the multifactorial nature of this problem.
Head and Neck
ü
Accurately perform flexible and rigid endoscopy for workup and staging of
malignancies.
ü
Appropriately select and interpret CT, MRI, and other radiographic
evaluations of the head and neck.
ü
Provide comprehensive care in the management of head and neck oncology,
including the role of organ preservation and quality of life issues, in
association with medical oncologists, radiation oncologists, oral surgeons,
prosthedontists, psychiatrists, and members of other surgical disciplines.
ü
Perform complex head and neck oncologic surgery such as neck dissection,
laryngectomy, composite resection, parapharyngeal space, skull base,
craniofacial resections, thyroidectomy, and salivary gland excision.
ü
Evaluate and manage thyroid and parathyroid disorders, and participate
effectively with endocrinologist in the evaluation and treatment of patients
with these disorders.
ü
Evaluate and manage the late treatment effects for this disease and provide
effective follow-up care.
Trauma/Plastic/Reconstructive
ü
Assess the influence of the aging process on facial aesthetics and function,
including rhytidosis, brow ptosis, eyelid disorders, and rhinophyma.
ü
Describe the management options and surgical techniques for these disorders.
ü
Evaluate and select reconstructive options after resection of head and neck
neoplasms.
ü
Perform local and regional flap reconstruction, as well as skin grafting,
full and split thickness.
The OTO-Y1 resident must:
General
ü
Efficiently and accurately assess patients in the outpatient clinic,
including history and otolaryngic physical exam, rigid and fiberoptic
endoscopy of the sinonasal tract/pharyx/larynx, and otomicroscopy.
ü
Participate in the hospital-based care of patients on the resident service,
and those admitted by attending staff.
ü
Perform initial assessment of consultation patients, both in the hospital
and in the emergency room, developing differential diagnoses and proposing
treatment plans.
ü
Evaluate and manage acute and chronic sinusitis, including interpretation of
associated imaging studies, medical/allergy therapy, and postoperative care.
ü
Competently perform nasal septoplasty, maxillary antrostomy, anterior
ethmoidectomy, turbinate reduction, tonsillectomy, and UP3.
ü
Develop skills in managing emergencies including airway obstruction,
epistaxis, and serious head and neck infections.
ü
Recognize voice disorders, particularly as they affect the geriatric
population, and their rehabilitation protocols.
ü
Demonstrate operative skills sufficient to perform, with minimal guidance,
general procedures such as those described above. Become familiar with the
techniques of more complex operations, and serve as an effective operative
assistant.
Otology
ü
Evaluate and manage, both medically and surgically, acute and chronic ear
disease. This includes interpretation of audiometry and CT/MRI. Apply
appropriate indications for these tests.
ü
Workup and manage SNHL, particularly it affects the aging population.
Select appropriate amplification.
ü
Workup and manage balance disorders, particularly it affects the aging
population. Appreciate the multifactorial nature of this problem.
ü
Competently perform ventilation tube insertion, myringoplasty, cerumen
removal, foreing body removal, and cavity debridement.
Head and Neck
ü
Distinguish benign from malignant from inflammatory lesions based on
physical exam and office endoscopy, and apply appropriate workup and
management algorithms.
ü
Select and interpret appropriate diagnostic imaging for head and neck
neoplasms.
ü
Perform staging panendoscopy. Consolidate this data with that obtained from
clinical and radiographic evaluation to accurately stage malignancies.
ü
Distinguish benign from malignant from inflammatory lesions, and describe
workup and management algorithms.
ü
Manage patients with head and neck neoplasia in conjunction with members of
a multidisciplinary team.
ü
Describe the histopathologic features of a lesion or neoplasm; distinguish
benign from malignant tumors. Recognize common head and neck neoplasms such
as squamous cell carcinoma, papillary thyroid carcinoma, pleomorphic
adenoma, and basal cell carcinoma.
Trauma/Plastic/Reconstructive
ü
Describe the pathophysiology and clinical findings associated with disorders
affecting the geriatric population, including rhytidosis, brow ptosis,
eyelid disorders, and rhinophyma.
ü
Evaluate and select reconstructive options after resection of head and neck
neoplasms.
ü
Perform local flap reconstruction, and skin grafting, full and split
thickness.
Pediatric Otolaryngology
The rotation in Pediatric Otolaryngology is primarily based at LeBonheur
Children’s Hospital. This is a 225 bed tertiary referral center emphasizing
general pediatric otolaryngology as well as unique problems associated with
the pediatric airway, otologic disease, congenital malformations, and
neoplasms. Additional experience at St. Jude’s Children’s Research Hospital
further enhances enriches this rotation, providing exposure to unusual
oncologic and immunopathologic disorders affecting the pediatric
population. The rotation, performed in the OTO-Y2 year, is under the
direction of Dr. Thompson with involvement of other UTMG faculty.
The OTO-Y2 resident must:
General
ü
Serve as an effective member on the team of pediatric and surgical residents
managing patients with disorders of the head and neck in children.
ü
Demonstrate proficiency for effective management of inpatients, ability to
diagnose and treat patients at the POB ENT clinic, accurately assess
consults, and communicate effectively with faculty and staff.
ü
Evaluate and manage common head and neck diseases with particular emphasis
on general pediatric otolaryngology, acute airway problems, acute
infections, trauma, chronic ear disease sino-nasal disorders, otitis media
and their surgical and medical treatments.
ü
Describe the pathophysiology and management of obstructive sleep apnea,
chronic tonsillitis, chronic adenotonsillitis, strep throat, childhood neck
masses and infectious diseases encountered in childhood, such as:
retropharyngeal abscess diagnosis and treatment, acute cervical adnoiditis
with abscess, irrigation and drainage, and the management of deep neck
abscess.
ü
Evaluate and manage pediatric sinusitis: bacterial, fungal, and viral.
Apply and interpret appropriate diagnostic imaging. Recognize and manage
complications and pending complications of pediatric sinus disease,
ü
Master basic otolaryngology procedures including ventilation tube insertion,
adenoidectomy, and tonsillectomy.
ü
Proficiently perform direct laryngoscopy, bronchoscopy, and esophagoscopy
for diagnostic purposes and for removal of foreign body.
ü
Comfortably perform pediatric tracheotomies electively and emergency as well
as manage the complication of these procedures.
ü
Describe and apply the proper settings, safety requirements, and techniques
to use the carbon dioxide laser.
ü
Evaluate and manage causes of dysphagia and dysphonia in children and
demonstrate the proper work up.
ü
Recognize and manage medically and surgically laryngeal papillomas.
ü
Demonstrate competency in the management of stridor including: Age-related
differential diagnosis, the proper work-up, and surgical management of
airway obstruction in a neonate, infant and child.
ü
Recognize the common systemic diseases in the pediatric population, and
manage their otolaryngic manifestations.
Otology
ü
Evaluate and manage chronic ear disease, in the middle ear and mastoid, and
its management. This includes medical therapy, ventilation tubes,
tympanoplasty, ossicular implants, and mastoidectomy (simple, modified,
radical).
ü
Carry out the workup and management of SNHL in the pediatric population,
including syndromic, nonsyndromic, congenital, and acquired causes.
ü
Participate in the process of newborn screening and describe the importance
of this endeavor.
ü
Apply the appropriate selection criteria (for candidacy) and surgical
technique for cochlear implantation. Participate with patients, families,
and other specialists in rehabilitation.
ü
Appropriately select and interpret audiologic, including OAE and ABR.
ü
Appropriately select and interpret radiologic data, including CT and MRI..
Head and Neck (augmented by St. Jude’s experience)
ü
Apply techniques involved in more complex operations, and with guidance, be
capable of performing neck dissection, submandibular gland excision, and
endoscopic sinus surgery.
ü
Participate in multidisciplinary management of children with oncologic
disease, particularly as chemotherapy, radiation, and hematologic
dysfunction affect the head and neck.
ü
Recognize the late treatment effects for childhood pediatric otolaryngologic
neoplasms and the importance of providing effective follow-up care.
Trauma/Plastic/Reconstructive
ü
Apply factors unique to the pediatric population regarding the management of
head and neck injuries.
ü
Explain the general systemic features of common congenital abnormalities
that may affect the head and neck. Effectively participate in a
multidisciplinary team approach for their management.
ü
Manage otolaryngic manifestations of congenital syndromes and malformations
(such as cleft lip and palate, mandibulofacial dysostosis, craniofacial
dysostosis.....) as they influence the airway, swallowing, cosmesis, and
otologic disease.
The St. Jude’s component of this rotation has the following unique goals
and objectives:
ü
Serve as an effective member on a multidisciplinary team managing pediatric
patients with malignancies of the head and neck.
ü
Evaluate and manage head and neck diseases with particular emphasis on head
and neck neoplasms, acute airway problems, acute infections, chronic ear
disease post radiation and sino nasal disorders of the immunocompromised
host.
ü
Apply techniques involved in more complex operations and with guidance, be
capable of performing neck biopsies, submandibular gland excision,
endoscopic sinus surgery, and tracheostomies.
ü
Manage these patients in the setting of comorbidities including
immunosuppression and coagulopathy.
ü
Evaluate and manage medical aspects of thyroid and parathyroid disorders and
participate effectively with endocrinologist in the evaluation and treatment
of these patients.
ü
Describe the role of all treatment modalities for head and neck malignancies
including the care required for patients during the complete treatment
period.
ü
Recognize the late treatment effects for pediatric otolaryngic neoplasms and
the importance of providing effective follow-up care.
Baptist Memorial Hospital/Otology
This is a large suburban hospital where a full spectrum of otolaryngology is
practiced in a private practice environment. The rotation is under the
supervision of Dr. Bruce MacDonald, with an emphasis on otology and
neurotology. This is a chief (OTO-Y4) resident experience for exposure to
suburban community otolaryngology practice, as well as to prepare him/her to
manage unique otologic conditions that may be encountered.
The OTO-Y4 resident must:
ü
Explain the pathophysiology of disease processes involving the skull base
and apply the various surgical approaches for resecting such lesions,
including CPA tumors/acoustic neuroma, paraganglioma, and tumors of EAC.
ü
Cooperate with other specialists including neurosurgery, neurotology, head
and neck surgery, interventional radiology, radiation oncology, and
reconstructive surgery in the comprehensive management of these lesions.
ü
Describe and apply the principles of facial nerve reanimation.
ü
Evaluate and manage chronic ear disease involving the middle ear and
mastoid. This includes medical therapy, ventilation tubes, tympanoplasty,
ossicular implants/ossiculoplasty, and mastoidectomy (simple, modified,
radical).
ü
Evaluate and manage complications of otomastoiditis.
ü
Explain the pathophysiology, clinical findings, and management
(amplification, medical, surgical) of otosclerosis, including the
stapedectomy procedure.
ü
Workup and manage SNHL, including the selection of amplification.
ü
Perform accurate evaluation for balance disorders.
ü
Apply the appropriate selection criteria (for candidacy) and surgical
technique for cochlear implantation. Participate with patients, families,
and other specialists in rehabilitation.
ü
Manage otologic manifestations of congenital syndromes and malformations,
such as cleft palate.
ü
Appropriately select and interpret audiologic data, including OAE and ABR.
ü
Appropriately select and interpret radiologic data, including CT and MRI.
ü
Show proficiency in responding to acute and emergency problems of the head
and neck.
ü
Perform an accurate assessment of patients in a suburban ambulatory care
setting and have complete knowledge of disease management.
ü
Competently perform general otolaryngology procedures with minimal guidance.
Research
A block of dedicated
research time is performed during the OTO-2 year. Under the guidance of
Herbert Gould, PhD and T.J. Yoo, MD, PhD, residents will undertake a project
worthy of presentation at a major meeting and/or publication.* This may be
either clinical or basic science in nature, and may draw upon the expertise
and resources of members of the otolaryngology faculty and/or those of
sister disciplines (allergy and immunology, oncology, radiation oncology,
pediatrics, neurobiology, anatomy, surgical pathology, audiology, speech
pathology…..)
The OTO-Y2 will:
ü
Learn and apply basic
statistical analysis for analyzing scientific data.
ü
Learn and apply basic research
design: develop the question, analyze existing data, form a hypothesis,
develop an approach to answer the question and test the hypothesis, and
execute this approach.
ü
Exhibit and promote ethical
behavior in biomedical research.
ü
Explore cutting edge research
topics and techniques available at our Medical Center.
ü
Present this research to the
research conference for critical evaluation by the department.
ü
Present this data at a
national or regional forum either as a poster or podium presentation.
ü
Submit this project for
publication in the medical literature.
*Research
requirements for graduation:
ü
During each academic year - submit at least one project for poster, podium
presentation, or publication. This may be a case report.
ü
