Otolaryngology PGYII

Description of Rotation or Educational Experience

The two-week rotation of ENT Medicine will prepare the resident to recognize, assimilate and master those aspects of ENT problems and diseases that are necessary for daily patient care. The needed skills will be obtained through several resources including the attending otolaryngologist’s in-patient and out-patient private patients and the resident’s panel of patients at the FMC, Family Medicine Service Rotations, didactic lectures, on-line resources (UpToDate, DynaMed) and conferences.

Goal I: At the end of this experience, the resident will have the knowledge and skill to manage common ENT problems seen by family physicians. 

Goal II: The resident will also learn to recognize the need for proper referral to an ENT specialist for problems that are beyond the scope of the resident’s capabilities

The resident is expected to:

• Attend three ½ day FMC clinics.
• Round with the otolaryngologist.
• See patients in the otolaryngology clinic.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

• Recognize and treat common otolaryngology problems
• Interpret outpatient tests
• Correctly examine the head and neck
• Perform otolaryngology procedures
• Provide referrals appropriately

Objectives

The resident will:

• Learn, observe and discuss common otolaryngology problems such as otitis media, rhinitis, sinusitis, laryngitis, vertigo, pharyngitis/tonsillitis and otitis externa in the settings detailed above.
• Observe, learn and discuss the interpretation of outpatient tests used in otolaryngology such as audiometry and tympanometry.
• Demonstrate proficiency in the use of instruments such as the indirect laryngoscope, nasopharyngoscope and pneumatic otoscope.
• Learn otolaryngology procedures such as removal of foreign bodies from the nose and ear, anterior nasal packing and cerumen removal.
• Understand and discuss the proper referral to otolaryngology specialists based on acuity and complexity of the condition.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

• Be able to assess/evaluate/treat common otolaryngology problems
• Properly interpret tests used in otolaryngology
• Properly seek consultation with an otolaryngology specialist

Objectives

• The resident will learn, observe and discuss common otolaryngology problems such as otitis media, rhinitis, sinusitis, laryngitis, vertigo, pharyngitis/tonsillitis and otitis externa, etc. in the settings detailed above.
• The resident will observe, learn and discuss the interpretation of outpatient tests used in otolaryngology such as audiometry and tympanometry     
• The resident will learn and discuss the proper referral to otolaryngology specialist based on acuity and complexity of the condition.

The resident will receive an introduction to the pathophysiology, diagnosis, and management of ENT problems including:

• Labyrinthitis and other labyrinthine disorders
• Epistaxis
• Foreign body in the ear
• Otitis externa
• Otitis media
• Serous otitis
• Pharyngitis
• Sinusitis
• Tonsillitis
• Adenoid/tonsillar hypertrophy
• Laryngitis
• Mastoiditis
• Benign ENT lesions
• Malignant ENT lesions
• Dizziness/vertigo
• Cervical masses
• Hoarseness
• Hearing loss
• Tinnitus
• Cholesteatoma
• Vocal cord nodules
• Perforated ear drum
• Peritonsilar abscess
• Rhinitis

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems

Objectives

• The resident will discuss the proper approach to the patient with the otolaryngology problems listed above with the otolaryngology preceptor and develop the necessary differential diagnoses and treatments to ensure proper patient care.
• The resident will use the resources listed above as well as primary or secondary literature to advance their knowledge in areas of otolaryngology where they have limited experience.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty.

Objectives

The resident will:

• Gain an understanding of the delivery of care to the otolaryngology patient in the in-patient and out-patient setting. 
• Demonstrate an understanding of the resources necessary to treat different types of otolaryngology problems.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others

Objectives

• The residents are exposed to patients from a diverse patient population during their otolaryngology rotation.  They are expected to meet the needs and expectations of the patients in the otolaryngology environment.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to communicate effectively with physicians, patients, and families.

Teaching Methods

Direct preceptor/resident interaction, in-patient rounds, out-patient private clinic.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References available at the AHEC Library:

Schuller DE. Deweese and Saunders: otolaryngology – head and neck surgery. 8^th ed., St. Louis, Mosby, 1994.

Gates: Current Therapy in Otolaryngology.

On Line Resources:

UpToDate and DynaMed