Medical Knowledge Objectives
At the completion of the PGY-4 rotation, residents should be able to have a comprehensive and up-to-date knowledge of general otolaryngology disease processes, specifically as it pertains to laryngology and facial plastic surgery. They should be able to elaborate and comprehensively describe each otolaryngologic condition starting with basic science mechanisms, clinical presentation, differential and definitive diagnosis, available and preferred testing modalities, comprehensive management including medical therapy and surgical procedures. Risks and benefits of treatments as well as potential complications and their management should be mastered. Specific curricular objectives for the PGY-4 resident include:
- Develop and demonstrate an understanding of the clinical presentation of head and neck surgery patients
- Continue to master basic and complex anatomy of the head & neck, skull base, cranial nerves and associated structures
- Develop an understanding of the pathophysiology and management of inflammatory, congenital, infectious, neoplastic, inflammatory, vascular, degenerative, traumatic, and idiopathic processes affecting the head & neck surgery patient and understanding of relevant basic science
- Interpret plain X-ray, CT and MRI imaging, photographic analysis of head & neck surgery patients
- Develop an understanding of the prevention, diagnosis, and treatment of head and neck disease through clinical experience (inpatient and outpatient), educational conferences, and textbook and journal readings
- Develop an understanding of the risks and indications for surgical intervention, including knowledge of the alternative treatments important in obtaining informed consent
- Recognize and develop treatment plans for head and neck operative complications.
- Actively participate in all departmental educational conferences and meetings
- Develop competence in critical review of the literature through journal club and independent reading
- Develop research skills and methods of scientific investigation through discussions with mentor, Grand Rounds and the department resident research presentations
- Be able to appropriately analyze the facial anatomy and profile with an in-depth understanding of the gender and ethnic differences
- Have a fundamental understanding of the reconstructive ladder for facial plastic and head and neck reconstruction
- Develop an understanding and proficiency in performing in-office facial plastic and laryngological procedures including nasopharyngoscopy/laryngoscopy, video stroboscopy, laryngeal injections and BOTOX chemodenervation.
Practice-Based Learning and Improvement Objectives
- Utilize practice-based learning as demonstrated by improvements in surgical technique with repeated performance of procedures and performance of procedures appropriate to level of training
- Demonstrate mastering of evidence-based medicine and literature review during routine clinical care (rounds and patient consultation presentations), departmental conferences (Grand Rounds, other required conferences) and in clinical case conferences
- Identify and analyze poor patient outcomes, complications and “near-miss” events in Quality Assurance conference
- Maintain accurate records of operative and clinical cases
- Monitoring of outcomes of patients with whom the resident has interacted during the rotation in the clinic and operating room; adjustment of technique/management based on observed outcomes
- Apply the principles of evidence-based medicine to one's own practice
- Use on-line resources for up-to-date information
- Be candid in presenting and critically analyzing one's outcomes and errors
- Take the initiative in identifying one's own areas of relative weakness/need for improvement, through consultation with faculty and resident colleagues, and address identified gaps in knowledge/skills
- Develop growth through participation in didactic sessions, continuing education programs, scientific presentations, and publications
- Carry out their professional duties, including continuity of care, responsiveness to changes in clinical situations, responsiveness and availability, in an ethical and confidential manner
- Demonstrate a commitment to and respect for the other members of the team (call responsibilities, equitable work distributions, appreciation, understanding)
- Demonstrate sensitivity to the cultural, gender, age, religious, socioeconomic status and aspects of patient care
- Learn to accept constructive criticism with an intention toward professional growth and learning
- Acquire skills necessary to obtain appropriate physician-patient relationships
- Continue honesty, compassion, level-headedness, decorum, selflessness, self-discipline, integrity and respect for others
- Acceptance of accountability and commitment to self-improvement
- Maintenance of patient confidentiality; knowledge of HIPPA statutes
- Understanding of ethical issues in clinical and research settings, and critical analysis of novel ethical issues
- Appropriate consultation with colleagues within and outside the department
- Ability to work as a member of a team
- Development of leadership skills
- Continue habits of continual learning
- Demonstrate respect for all members of the health care team including outpatient/clinic, inpatient, emergency department and operating room staff
- Engage in moral and ethical behavior by focusing and providing quality patient care
Interpersonal and Communication Skills Objectives
- Master previous training objectives in this competency.
- Complete a comprehensive informed consent discussion with the patient, including risks, benefits, and alternatives for the planned procedure.
- Communicate with patient’s family honestly and supportively.
- Encourage patient to discuss his/her concerns (e.g., using continuers such as, “tell me more”, “go on”, etc.).
- Create an atmosphere of respect through patient participation in decision-making.
- Become proficient at eliciting information from difficult or apprehensive patients.
- Be able to present a patient clinical summary for multidisciplinary conferences.
- Demonstrate competence in presenting information in public forums, such as national meetings and conferences.
Systems-Based Practice Objectives
- Master previous training objectives in this competency
- Understanding of the organization of the HMH service, including expected responsibilities, the hierarchy of the team, and the mechanisms of supervision and communication.
- Organizational and time-management skills required for efficient running of the inpatient service
- Familiarization and utilization of the Time-Out for identification and prevention of potential adverse events
- Understanding of the systems approach to analysis of sentinel events signifying a potential risk to patient safety
- Become familiar with the outpatient, inpatient, operating room, and emergency room facilities at HMH and resources available to the team
- Identification of opportunities to systematically improve care delivery
- Understanding of macro- and microeconomic forces impacting health care delivery to different populations and to single individuals
- Cost-effective use of diagnostic tests and treatment modalities
- Introduce the resident to quality management, ethics, risk management, socioeconomic issues, and medical staff issues and responsibilities