Download Residency Educational Goals and Objectives

2011‐2012
EDUCATIONALGOALS&OBJECTIVESBYROTATION
GENERALSURGERY
PGY1:SURGICALINTENSIVECAREUNIT(SICU)
Goals
1. Developtheabilitytorapidlyevaluate,diagnose,stabilize,and
dispositioncriticallyillpatients.
2. Learnrespiratory,cardiovascular,renalandneurologicphysiology
andthepathophysiologyoftrauma,toxins,shock,sepsis,cardiac
failure,andrespiratoryfailurethataffectcriticallyillpatients.
3. Learntheprinciplesofmedicalinstrumentationandhemodynamic
monitoringandbeabletoutilizetheminthecareofcriticallyill
patients.
4. Learntheindicationsanddevelopthetechnicalskillsneededto
performdiagnosticandtherapeuticinterventionsincriticallyill
patients.
5. Learntherationaluseoflaboratory,radiographicandother
diagnostictestsinthemanagementofcriticallyillpatients.
6. Understandtheetiologiesandpathophysiologyofcardiacarrest.
7. Learntorecognizethedysrhythmiasassociatedwithcardiac
arrestandtheirtreatment.
8. LearntheAHAandACSadvancedlifesupportrecommendations
anddevelopskillintheperformanceofstandardresuscitative
procedures.
9. Learntheprinciplesofpharmacotherapyandtheroutesand
dosagesofdrugsrecommendedduringresuscitations,cardiac
arrestandprolongedintensivecare.
10. Learntheindicationsforwithholdingandterminating
resuscitation.
11. Thisisa1monthrotation.
LearningObjectives:CoreCompetencies
Professionalism:
1.
Demonstrateanunderstandingoftheethicalandlegalprinciples
applicabletothecareofcriticallyillpatients.
2.
Demonstrateunderstandingof“Donotresuscitate”orders,
advancedirectives,livingwills.
Interpersonal&CommunicationSkills:
1. Presentsign‐outofpatientsinacompleteandresponsiblemanner.
MedicalKnowledge:
1. Demonstrateappropriateprioritizationofdiagnosticandtherapeuticinterventionsincriticallypatients.
2. Demonstrateabilitytodiagnoseandtreatshock,sepsis,fluidandelectrolyteabnormalities,andcardiac
failure.
3. Demonstrateabilitytomanagetheairwayduringcardiacarrest,includingmouth‐to‐mouthventilation,
bag‐valve‐maskventilation,endotrachealintubation,cricothyroidotomy,andrecognitionofthe
obstructedairway.
4. Demonstrateabilitytoperformexternalclosedchestcardiopulmonaryresuscitation.
Practice‐BasedLearning&Improvement:
1. Interactwithotherhospitalswithregardtoacceptanceordenialofpatientsfortransfer.
PatientCare:
1. Demonstrateabilitytorapidlyperformhistoryandphysicalexamsincriticallyillpatients.
2. Demonstratetheabilitytoperformthefollowingprocedures:oralendotrachealintubation,central
intravenousplacement,andFoleycatheterization.
3. DemonstratetheabilitytouseandinterpretdatafromECGmonitors,arterialbloodgases,pulse
oximetry,endtidalCO2monitorsandrespirators.
4. Describetheindicationsandcontraindicationsofpharmacologicinterventionsforshock,cardiacfailure,
dysrhythmias,sepsis,trauma,toxins,respiratoryfailure,hepaticfailure,renalfailure,andneurologic
illnesses.
5. Demonstratetheabilitytomanageapatientonaventilator.
6. Demonstrateappropriatejudgmentinthemanagementofcriticallyillpatients.
Systems‐BasedPractice:
1. Demonstrateanunderstandingoftheappropriateuseofconsultantsincriticallyillpatients
PGY1:NEUROSURGERY
Goals
Understandtherelationshipbetweentheskullbaseandthebrain,andtoappreciateneurosurgical
emergenciesandhowtotreatthem.Asmanystructuresintheskullbase,suchasthesinusesandthetemporal
bone,arepotentialparameningealfociforinfectionsortrauma,theresidentwillunderstandtheimportanceof
diseaseprocessesinthenose,earsandsinusestothebrain.Thisisa1monthrotation.
LearningObjectives:CoreCompetencies
Professionalism:
1. Todemonstratecompassionandintegritythroughrespectfulpatientcare,familyinteractions,and
communicationwithotherhealthcareproviders.
2. Tounderstandwhenexpertmedicaladviceisnecessary.
3. Toobtainexpertmedical,nursing,orotheropinionswhenlimitsofknowledge,experience,andtraining
arereached.
Interpersonal&CommunicationSkills:
1. Topresentclinicalinformationonworkroundsclearlyandconcisely.
2. Towriteprogressnoteswithsufficientdetailsothatpatients’condition,statusandcareplansareclear.
3. Toworkeffectivelywithattendingstaff,housestaffcolleaguesinsurgeryandpediatricservices,medical
students,nurses,ancillarypersonnel,pre‐hospitalpersonnel.
4. Tokeepseniorresidentsandattendingstaffinformed,particularlywith“problem”cases,unstable
patients,andchangesin‐patientconditionandcareplan.
MedicalKnowledge:
1. Toexpandfundofknowledgefromtextbooks,journals,andelectronicmedia,especiallyregarding
neurosurgicalemergencies,headtrauma,andCSFleaks.
Practice‐BasedLearning&Improvement:
1. Toevaluatepatientscriticallywiththegoalofcomingupwithaworkingdiagnosisandtreatmentplan.
2. Tounderstandthemedical,surgical,andscientificbasesofapatient’sconditionandhisorhertreatment
plan.
3. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,work‐up,orhospitalcourse
whennecessary.
PatientCare:
1. Toknowup‐to‐presentdetailsofallassignedpatients.
2. Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including:
a. Learningtoobtainclinicalinformationfromchildrenandparents.
b. Obtainingrelevantinformationfromnursesandhospitaldepartments(e.g.,radiology,laboratory,
andhospitalinformationsystems).
c. Obtaininginformationfromreferringpediatricians,hospitals.
3. Tolearntheprinciplesofpreandpostoperativemanagement,including:
a. Fluidandelectrolytemanagement.
b. Pharmacologicalmanagement,includingpainandsedation,antibioticdosingandpharmacology.
c. Recognitionandmanagementofrespiratorydistressandshock.
d. Woundcare.
e. Follow‐upandoutpatientmanagement,includingreferralsandresourcesforsocialwork,
rehabilitationandphysicalmedicine.
4. Toperformbasicclinicalprocedures,including:
a. Primaryclosureofincisions.
b. Managementofopenandinfectedwounds.
c. Lumbarpuncture.
d. Intravenouslineplacement.
Systems‐BasedPractice:
1. Toeffectivelytransfercarewhendutyhoursarecompleted.
2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.
3. Toapplystandardizedcareplans,andtherationalebehindthem,including:
a. Admissionforheadtrauma.
b. Managementofintracranialpressure.
c. Clearanceofthecervicalspine.
4. Toparticipateincareconferencesonassignedpatients.
5. Towritenoteswithsufficientdetailtosatisfytherequirementsofgovernmentalagencies,healthcare
payerorganizations,including:
a. Admissionhistories,physicalexaminations,andcareplans.
b. Dailyprogressnotes,anddischargesummaries.
PGY1:GENERALANDPEDIATRICSURGERY
ClinicalMission/Goals
TheclinicalmissionoftheDivisionofPediatricSurgeryattheUniversityofNorthCarolinaatChapelHillisto
providethehighestlevelofcareininfants,childrenandadolescentswithcongenitalandacquiredconditions
thatrequiresurgery.Ourgoalsincludecaringforcomplexcongenitalmalformations,advancedsurgical
conditionsandcaringforcomplicatedcasesinamultidisciplinaryfashion.
EducationalMission
Objectivesreflectteamwork;i.e.,theskillsandresponsibilitiesblendsothattheycomplementcontributions
fromothermembersofthephysicianteamandrecognizetheinputfromnursingandotheralliedhealth
professionals.
LearningObjectives:CoreCompetencies
Professionalism:
1. Todemonstratecompassionandintegritythroughrespectfulpatientcare,familyinteractions,and
communicationwithotherhealthcareproviders.
2. Tounderstandwhenexpertmedicaladviceisnecessary.
3. Toobtainexpertmedical,nursing,orotheropinionswhenlimitsofknowledge,experience,andtraining
arereached.
Interpersonal&CommunicationSkills:
1. Toevaluatepatientscriticallywiththegoalofcomingupwithaworkingdiagnosisandtreatmentplan.
2. Tounderstandthemedical,surgical,andscientificbasesofapatient’sconditionandhisorhertreatment
plan.
3. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,work‐up,orhospitalcourse
whennecessary.
4. Toparticipateinteachingthemedicalstudents.
MedicalKnowledge:
1. Toexpandthefundofknowledgefromtextbooks,journals,andelectronicmedia,especiallyinregardsto
pediatricsurgeryconditions,includingdiaphragmatichernia,Hirschsprung’sdisease,pyloricstenosis
andcloacalabnormalities.
2. Tocriticallyevaluatetheliteraturebaseduponmethodologyandstatisticaltechniques,asurveyof
relatedarticles,andresident‐initiateddiscussionswithattendingstaffandotherexperts.
Practice‐BasedLearning&Improvement:
1. Topresentclinicalinformationonworkroundsclearlyandconcisely.
2. Towriteprogressnoteswithsufficientdetailsothatpatients’condition,statusandcareplansareclear.
3. Toworkeffectivelywithattendingstaff,housestaffcolleaguesinsurgeryandpediatricservices,medical
students,nurses,ancillarypersonnel,pre‐hospitalpersonnel.
4. Tokeepseniorresidentsandattendingstaffinformed,particularlywith“problem”cases,unstable
patients,andchangesin‐patientconditionandcareplan.
5. Tofosterteamworkandaworkenvironmentbaseduponcommunication,respect,trustandhonesty.
6. Tofosterasocialenvironmentbasedupontoleranceforotheropinions, backgrounds,andcultures.
PatientCare:
1. Toknowdetailsofallassignedpatients.
2. Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including:
a. Learningtoobtainclinicalinformationfromchildrenandparents
b. Obtainingrelevantinformationfromnursesandhospitaldepartments(e.g.,radiology,laboratory,
andhospitalinformationsystems)
c. Obtaininginformationfromreferringpediatricians,hospitals.
3. Tolearntheprinciplesofpreandpostoperativemanagement,including:
a. Fluidandelectrolytemanagement.
b. Pharmacologicalmanagement,includingpainandsedation,antibioticdosingandpharmacology.
c. Recognitionandmanagementofrespiratorydistressandshock.
d. Woundcare.
e. Follow‐upandoutpatientmanagement,includingreferralsandresourcesforsocialwork,
rehabilitationandphysicalmedicine.
4. Toperformbasicclinicalprocedures,including:
a. Primaryclosureofincisions.
b. Managementofopenandinfectedwounds.
c. Venipuncture.
d. Intravenouslineplacement.
e. Placementofurinarycatheters.
Systems‐BasedPractice:
1. Toeffectivelytransfercarewhendutyhoursarecompleted.
2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.
3. Toapplystandardizedcareplans,andtherationalebehindthem,including:
a. Bowelpreparationprocedures.
b. Preoperativeantibioticregimens.
c. S.B.E.prophylaxis.
d. Tetanusprophylaxis.
e. Universalprecautions.
f. Aseptictechnique.
g. Careofcentrallines.
h. Careofgastrostomies.
i. Postoperativefeedingregimens(e.g.,post‐pyloricregimens).
4. Toattendcareconferencesonassignedpatients.
5. Towritenoteswithsufficientdetailtosatisfytherequirementsofgovernmentalagencies,healthcare
payerorganizations,including:
a. Admissionhistories,physicalexaminations,andcareplans.
b. Dailyprogressnotes.
c. Dischargesummaries.
DidacticCurriculum
1. WeeklyDivisionpreoperativeworkconference.
2. Weeklycombinedprenatalconference(withNeonatology,PerinatalMedicine,andHigh‐riskObstetrics).
3. WeeklyPulmonaryConference(withPediatricPulmonology).
4. MonthlyPediatricChairrounds(withwardservices,DepartmentofPediatrics).
5. Dailymedicalstudentconference.
6. MorbidityandMortalityConference(withDivisionsofGeneralSurgeryintheDepartmentofSurgery).
7. Resident‐as‐Teacherconference(withDepartmentofSurgery).
Evaluation
Attendingstaffevaluatesresidentperformancebaseduponthesixcorecompetenciesrelevanttohisorher
postgraduatelevelsummarizedabove.Theseniorresidentsassistintheevaluationofjuniorlevelresidents.
End‐of‐rotationfacultymeetingsassessinadditionthestrengthsandweaknessesoftheresidents.Completed
evaluationformssummarizetheseevaluations.Facultyandresidentsmeet,usingtheevaluationforasaguide
forconstructivediscussion.Theymakeplanstoaddressperceivedresidentweaknesses.Partofthediscussion
addressesthequalityoftheeducationalexperienceonthePediatricSurgery
PGY1:TRAUMASURGERY
OtolaryngologyPGY1ResidentsparticipateintheDepartmentofGeneralandTraumaSurgeryatWakeMed
Hospitals.Residentsparticipateinallaspectoftheclinicalpracticeincludingoutpatientclinic,initialtrauma
assessments,intra‐operativeandpost‐operativecareoftraumapatientsacrossthedurationoftheirone(1)
monthrotation.
Goals
1. Toapplythemostup‐to‐dateproceduresinanappropriatecontextusingsolidmedicalandscientific
information.
2. Tocareforcomplexthermalandelectricalinjuries,advancedsurgicalconditions,andthemost
complicatedcasesinamultidisciplinaryfashionusingtheskillsandknowledgeofourmedicaland
nursingcolleagues.
3. Toexpandthesphereofcaretoincludethecommunitynursesandsocialcarenetworkinthehome
communityineffortsthatincludeeducationandcommunication.
4. Torespectthepatientandhisorherfamilyduringallphasesofcare,includingeffortstoprovidecareina
comfortable,caringenvironment.
5. Topromoteaneducationalenvironmentwheredecisionsareinformed,questionsareanswered,and
patientsaretreatedwithkindness.
6. Thisisa2monthrotation.
Surgeryresidentsandmedicalstudents,asmembersoftheNorthCarolinaJayceeBurnCenter,willsupportthe
clinicalmissionandallgoalsoftheDivision.
LearningObjectives–CoreCompetencies
Theemphasisofthisrotationisontheacutecareofthetraumapatient.Thisincludesinitialassessment
followinginjury,stabilizationandresuscitation,pre‐operativeevaluation,intra‐operativemanagement,
postoperativecare,andoutpatientfollow‐up.
Professionalism:
1. ThePGY1isexpectedtoparticipateinORcases,inclinic,orinICUmanagementonadaytodaybasis.
2. Bywayofexampleanddirectinstructiontomedicalstudents,todemonstrate compassionandintegrity
throughrespectfulpatientcare,familyinteractions,andcommunicationwithotherhealthcareproviders.
Interpersonal&CommunicationSkills:
1. ThePGY1shouldunderstandthathisorherprimaryroleistogatherinformationforthePGY3and
attendingstomakeinformeddecisionsabouttreatmentplans,aswellastocarryoutthosetreatment
plans.
2. ThePGY1isexpectedtoassistindocumentingfullythepatient’shospitalcourse,includingaprecise
historyandphysical,comprehensivedischargesummaryanddailyprogressnotes.
3. Toreviewteamordersandprogressnotesfordetailandaccuracy.
4. Toprovideinformedopinionsduringconsultationswithotherservicesinathoughtful,respectful
manner.
5. Toadvisepatientsandfamilymembersinthedecisionmakingprocess.
6. Toobtaininformedconsentfrompatientsorfamilymembers.
MedicalKnowledge:
1. ThePGY1isexpectedtoreadachapterontraumacareinoneofthesurgicaltextbooks.
2. Tocontributesubstantivelyinscheduledconferences.
Practice‐BasedLearning&Improvement:
1. Tocontributetoworkroundssothatdiagnosticandtreatmentissuesareidentifiedandcaretasksare
initiatedandcompletedinanappropriateandtimelymanner.
2. Toprovideinformationandresourcessothattheteamunderstandsthemedical,surgical,andscientific
basesofapatient’sconditionandhisorhertreatmentplan.
PatientCare:
1. Learntoevaluatepatientswithminortomulti‐systemtrauma,includingassessmentfortheneedfor
hospitalization,aswellasimmediateresuscitationneeds.ThePGY1shouldbeabletocommunicatethis
assessmenttothePGY3(chiefresident)ortotheattending.
2. ThePGY1isexpectedtoroundonadailybasisonhospitalizedpatients,performingacompletephysical
examination,acquiringanupdateonpertinentlaboratoryandradiologicalexaminations,andcompiling
thisinformationintoaconcisepresentationtobemadeonmorningrounds.
3. ThePGY1shouldbeabletoevaluatethetraumapatientforneedsrelatedtofluidandelectrolyte
management,assessmentandtreatmentofpainandanxiety,andappropriatesupplementationfor
nutritionalneeds.
4. Tobeabletoinitiatetreatmentinthetraumabayandintensivecaresetting.
5. Toprovideadvancedtraumacareandlifesupport.
6. ThePGY1shouldbeabletorecognizetheneedforassessmentofthetraumapatientforinfections,
shouldbeabletofollowanalgorithmfordiagnosingthesourceofinfection,andinitiatingatreatment
planthatincludesappropriateantibiotics.
7. ThePGY1isexpectedtobecomeproficientatarterialandvenouscatheterizationinthetraumabay,
includingtheplacementofpercutaneousfemoralvenouslines,andplacementofperipheralintravenous
lines.UndersupervisionofthePGY3,thePGY1isalsoexpectedtobecomeproficientinplacementof
subclavianandinternaljugularvenouslines.
8. ThePGY1willbeexpectedtoassessthepatientfornutritionalstatus.Thiswillincludeassessingthe
extentofthepatient’sweightloss,trackingtheweeklyserumproteinslevels,followingthedietitian’s
notesinthechart,anddeterminingtheappropriatetimingformetaboliccartstudies.ThePGY1will
alsobeexpectedtounderstandtherationalefortheenteralfeedingsemployedinthesupportoftheburn
patient.
9. ThePGY1willbeexpectedtoassessthepatientinitiallyforneedforintubation,eitherbecauseofsmoke
inhalationinjury,swellingoftheupperairway,orcarbonmonoxidepoisoning.Duringthesubsequent
hospitalization, thePGY1willalsobeexpectedtolearnmanagementoftheventilator,aswellasto
preparethepatientforweaningandextubation.
11. ThePGY1willbeexpectedtoanticipateandidentifythepatientgoingintosepticshock.Subsequently
thePGY1willbeexpectedtomanagethefluidresuscitationofthepatient,aswellasworkwiththePGY3
intermsofmanaginginotropicsupport.
Systems‐BasedPractice:
1. Toassurethatprioritiesofcareandservicedutiesaretransferredcompletelyandresponsiblyon
changesindutyhours.
2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.
3. Tosupervisetheapplicationofstandardizedcareplans.
4. Toidentifyproblemsandinefficienciesintheprovisionofpatientcare,anddevisemeansofassessing
andaddressingthem.
PGY1:NCJAYCEEBURNCENTER
ClinicalMission
TheclinicalmissionoftheNorthCarolinaJayceeBurnCenterattheUniversityofNorthCarolinaatChapelHill
istoprovidethehighestlevelofcaretopatientsofallageswithskintraumaorskindiseases.
Goals
1. Toapplythemostup‐to‐dateproceduresinanappropriatecontextusingsolidmedicalandscientific
information.
2. Tocareforcomplexthermalandelectricalinjuries,advancedsurgicalconditions,andthemost
complicatedcasesinamultidisciplinaryfashionusingtheskillsandknowledgeofourmedicaland
nursingcolleagues.
3. Toexpandthesphereofcaretoincludethecommunitynursesandsocialcarenetworkinthehome
communityineffortsthatincludeeducationandcommunication.
4. Torespectthepatientandhisorherfamilyduringallphasesofcare,includingeffortstoprovidecareina
comfortable,caringenvironment.
5. Topromoteaneducationalenvironmentwheredecisionsareinformed,questionsareanswered,and
patientsaretreatedwithkindness.
6. Thisisa1monthrotation.
Surgeryresidentsandmedicalstudents,asmembersoftheNorthCarolinaJayceeBurnCenter,willsupportthe
clinicalmissionandallgoalsoftheDivision.
LearningObjectives–CoreCompetencies
Theemphasisofthisrotationisontheacutecareoftheburnpatient.Thisincludesinitialassessment
followinginjury,stabilizationandresuscitation,pre‐operativeevaluation,intra‐operativemanagement,
postoperativecare,andoutpatientfollow‐up.
AprimarymissionoftheNorthCarolinaJayceeBurnCenteristotraingeneralsurgeonstoprovideahighlevel
ofburnsurgicalcareappropriatetoacommunitygeneralsurgicalpractice,andtoprepareselectedtraineesfor
additionalspecialtytraininginburnsurgeryataburnsurgicalfellowship.
Objectivesreflectteamwork;i.e.,theskillsandresponsibilitiesblendsothattheycomplementcontributions
fromothermembersofthephysicianteamandrecognizetheinputfromnursingandotheralliedhealth
professionals.ManyobjectivesarenotspecifictotheNorthCarolinaJayceeBurnCenter,however,andare
reinforcedinallPGY1levelsrotations.
Professionalism:
1. ThePGY1isexpectedtoparticipateinORcases,inclinic,orinICU managementonadaytodaybasis.
2. Bywayofexampleanddirectinstructiontomedicalstudents,todemonstratecompassionandintegrity
throughrespectfulpatientcare,familyinteractions,andcommunicationwithotherhealthcareproviders.
3. ThePGY1isexpectedtobepresentintheburncenterasmuchaspossible,duringthoseperiodswhenhe
orsheisoncall.
Interpersonal&CommunicationSkills:
1. ThePGY1shouldunderstandthathisorherprimaryroleistogatherinformationforthePGY3and
attendingstomakeinformeddecisionsabouttreatmentplans,aswellastocarryoutthosetreatment
plans.
2. ThePGY1isexpectedtodocumentfullythepatient’shospitalcourse,includingaprecisehistoryand
physical,comprehensivedischargesummaryanddailyprogressnotes.
3. Toinstructmedicalstudentsonpresentationskillssothatclinicalinformationisclearandconcise.
4. Toreviewteamordersandprogressnotesfordetailandaccuracy.
5. Toprovideinformedopinionsduringconsultationswithotherservicesinathoughtful,respectful
manner.
6. Toadvisepatientsandfamilymembersinthedecisionmakingprocess.
7. Toobtaininformedconsentfrompatientsorfamilymembers.
MedicalKnowledge:
1. ThePGY1isexpectedtoreadachapteronburncareinoneofthesurgicaltextbooks.
2. Tocontributesubstantivelyinscheduledconferences.
Practice‐BasedLearning&Improvement:
1. Tocontributetoworkroundssothatdiagnosticandtreatmentissuesareidentifiedandcaretasksare
initiatedandcompletedinanappropriateandtimelymanner.
2. Toprovideinformationandresourcessothattheteamunderstandsthemedical,surgical,andscientific
basesofapatient’sconditionandhisorhertreatmentplan.
PatientCare:
1. Learntoevaluatepatientswithsmalltomoderatesizedburns,includingassessmentfortheneedfor
hospitalization,aswellasimmediateresuscitationneeds.ThePGY1shouldbeabletocommunicatethis
assessmenttothePGY3(chiefresident)ortotheattending.
2. ThePGY1isexpectedtoroundonadailybasisonallhospitalizedpatients,performingacomplete
physicalexamination,acquiringanupdateonpertinentlaboratoryandradiologicalexaminations,and
compilingthisinformationintoaconcisepresentationtobemadeonmorningrounds.
3. ThePGY1shouldbeabletoevaluatetheburnpatientforneedsrelatedtofluidandelectrolyte
management,assessmentandtreatmentofpainandanxiety,andappropriatesupplementationfor
nutritionalneeds.
4. Tobeabletoinitiatetreatmentintheemergencyroomandintensivecaresetting.
5. Toprovideadvancedtraumacareandlifesupport.
6. ThePGY1isexpectedtoparticipateinthecase,includingmakingandapplyingburndressings,
harvestingskinforautografting,meshingbothautoandhomograft,preparingthewoundbedfor
grafting,andapplyingtheskingraftstothewoundbed.
7. ThePGY1shouldbeabletorecognizetheneedforassessmentoftheburnpatientforinfections,should
beabletofollowanalgorithmfordiagnosingthesourceofinfection,andinitiatingatreatmentplanthat
includesappropriateantibiotics.
8. ThePGY1isexpectedtobecomeproficientatarterialandvenouscatheterizationintheburnintensive
careunit,includingplacementofpercutaneousarteriallines(includingPiCCOcatheters),placementof
percutaneousfemoralvenouslines,andplacementofperipheralintravenouslines.Undersupervisionof
thePGY3,thePGY1isalsoexpectedtobecomeproficientinplacementofsubclavianandinternaljugular
venouslines.
9. ThePGY1willbeexpectedtoassessthepatientfornutritionalstatus.Thiswillincludeassessingthe
extentofthepatient’sweightloss,trackingtheweeklyserumproteinslevels,followingthedietitian’s
notesinthechart,anddeterminingtheappropriatetimingformetaboliccartstudies.ThePGY1will
alsobeexpectedtounderstandtherationalefortheenteralfeedingsemployedinthesupportoftheburn
patient.
10. ThePGY1willbeexpectedtoassessthepatientinitiallyforneedforintubation,eitherbecauseofsmoke
inhalationinjury,swellingoftheupperairway,orcarbonmonoxidepoisoning.Duringthesubsequent
hospitalization,thePGY1willalsobeexpectedtolearnmanagementoftheventilator,aswellasto
preparethepatientforweaningandextubation.
11. ThePGY1willbeexpectedtoanticipateandidentifythepatientgoingintosepticshock.Subsequently
thePGY1willbeexpectedtomanagethefluidresuscitationofthepatient,aswellasworkwiththePGY3
intermsofmanaginginotropicsupport.
Systems‐BasedPractice:
1. Toassurethatprioritiesofcareandservicedutiesaretransferredcompletelyandresponsiblyon
changesindutyhours.
2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.
3. Tosupervisetheapplicationofstandardizedcareplans.
4. Toidentifyproblemsandinefficienciesintheprovisionofpatientcare,anddevisemeansofassessing
andaddressingthem.
Didacticcurriculum
1. WeeklyInterdisciplinaryTeamConference.
2. MorbidityandMortalityConference.
3. DepartmentofSurgeryGrandRounds.
4. Residenttopicconference.
5. Lifeafterresidencycourse.
6. Residentasteacherconference.
Evaluation
Residentsareevaluatedbythefaculty.Theseniorresidentsparticipateintheevaluationofthejunior
residents.End‐of–the‐rotationfacultymeetingsassessthestrengthsandweaknessesoftheresidents.
Evaluationformsarecompletedandtheresidentsareencouragedtomeetwiththefacultyattheconclusionof
therotation.Feedbackisdistributedduringtherotationsuchthatresidentscanaddressdeficiencies.The
facultytakesintoaccountpatientcare,operativetechniques,attitudeandcommunicationwithothers.The
opinionsofparamedicalpersonnel,patients,familiesandothersareconsideredduringtheevaluationprocess.
Theresidentsareencouragedtoprovidefeedbacktothefacultyregardingthestrengthsandweaknessofthe
surgicalexperienceattheNorthCarolinaJayceeBurnCenter.
PGY1:PLASTICSURGERY
Goals
Understandthetreatmentofwoundcare,skinclosuretechniques,andwoundmanagementintheoverall
surgicalmanagementofthepatient.Inaddition,theresidentshouldappreciatethecomplexityand
interdisciplinarycareofthepatientwithacleftpalate.Thisisa1monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Todemonstratecompassionandintegritythroughrespectfulpatientcare,familyinteractions,and
communicationwithotherhealthcareproviders.
2. Tounderstandwhenexpertmedicalcareisnecessary.
3. Toobtainexpertmedical,surgical,nursing,orother(alliedhealth,socialwork,legal)opinionswhen
limitsofknowledge,experience,andtrainingarereached.
Interpersonal&CommunicationSkills:
1. Topresentclinicalinformationonworkroundsclearlyandconcisely.
2. Towriteprogressnoteswithsufficientdetailsothatpatient’scondition,status,andcareplansareclear.
3. Toworkeffectivelywithattendingstaff,housestaff,medicalstudents,nurses,physician’sassistants,
ancillarypersonnel,andothermembersofthehealthcareteam.
4. Tokeepseniorresidentsandattendingstaffinformed,particularlywithcomplexcases,unstablepatients,
post‐operativepatients,andchangeswithpatientcondition.
5. Tofosterteamworkandaworkenvironmentbaseduponcommunication,respect,trust,honesty,and
altruism.
6. Tofosterasocialenvironmentbasedupontoleranceforotheropinions,backgrounds,andcultures,
withoutdiscriminationbasedupongender,race,religion,age,sexualpreference,economicstatus,or
bodyimage.
MedicalKnowledge:
1. Toexpandthefundofknowledgeinplasticsurgeryfromtextbooks,journals,ande‐media.
2. Tocriticallyevaluatetheliterature,baseduponmethodologyandstatisticaltechniques,surveyofrelated
articles,andresident‐initiateddiscussionswithattendingstaffandotherexperts.
3. Toparticipateinscheduledconferences.
Practice‐BasedLearning&Improvement:
1. Toevaluatepatientscritically,withthegoalofdevelopingaworkingdiagnosisandtreatmentplan.
2. Tounderstandthemedicalandsurgicalbasisofapatient’sconditionandtreatmentplan.
3. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,workup,orhospitalcourse,when
necessary.
PatientCare:
1. Toknowup‐to‐presentdetailsofallassignedpatients
2. Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including:
a. Obtainingclinicalinformationfrompatients.
b. Obtainingrelevantinformationfromnurses,houseofficers,andhospitaldepartments(e.g.
radiology,laboratory,hospitalinformationsystems). c. Obtaininginformationfromreferringphysiciansandhospitals.
3. Tolearntheprinciplesofpre‐andpost‐operativemanagement,including:
a. Fluidandelectrolytemanagement.
b. Pharmacologicmanagement,includingpainandsedation,antibioticdosingandpharmacology,DVT
prophylaxis,anticoagulationforfreetissuetransfer.
c. Flapphysiologyandassessment.
d. Woundcare.
e. Donorsiteevaluation.
f. Managementofdrains.
g. Familiaritywithsubatmosphericspongedressings(woundVAC),tissue‐engineeredskin replacements(Integra,AlloDerm,TransCyte),topicalantimicrobials(Thermazene,Sulfamylon,
silvernitrate,Acticoat),topicalgrowthfactors(Panafil,Regranex),andleeches(Hirudomedicinalis).
h. Follow‐upandoutpatientmanagement,includingreferralstosocialwork,homehealthnursing,
rehabilitationandphysicalmedicine.
4. Toperformbasicclinicalprocedures,including:
a. Managementofopenandinfectedwounds,includingdebridementanddressingcare.
b. Primaryclosureofincisions.
c. Venipuncture.
d. Placementofurinarycatheters.
e. Applicationofleeches.
f. Deliveryoflocalanesthetics.
Systems‐BasedPractice:
1. Toeffectivelytransfercarewhendutyhoursarecompleted.
2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.
3. Toapplystandardizedcareplansandunderstandtheirrationale:
a. Peri‐operativeantibioticregimens.
b. Universalprecautions.
c. DVTprophylaxis.
d. Draincare.
e. Pulmonarytoilet.
f.
Post‐operativephysicaltherapy.
g. Careofcentrallines.
h. Flapmonitoring.
i. Anticoagulationforfree‐tissuetransfer.
4. Toattendcareconferencesonassignedpatients.
5. Towritenoteswithsufficientdetailtosatisfytherequirementsofconsultantphysicians,discharge
planners,legalrepresentatives,governmentalagencies,andhealthcarepayerorganizations,including:
a. Admissionhistories,physicalexaminations,andcareplans.
b. Dailyprogressnotes.
c. Dischargesummaries.
PGY1:THORACICSURGERY
Goals/EducationalMission
AmissionoftheDivisionistotraingeneralsurgeonstoprovideahighlevelofsurgicalcareappropriatetoa
communitygeneralsurgicalpractice,toknowwhentoreferpatientstoacertifiedthoracicsurgeonandto
prepareselectedtraineesforadditionalspecialtytraininginacertifiedthoracicsurgeryresidency.Objectives
reflectteamwork;i.e.,theskillsandresponsibilitiesblendsothattheycomplementcontributionsfromother
membersofthephysicianteamandrecognizetheinputfromnursingandotheralliedhealthprofessionals.
Thisisa1monthrotation.
ClinicalMission
Providethehighestlevelofcareforpatientswithcongenitalandacquiredconditionsofthechestincludingthe
heart,lungs,esophagus,chestwallandassociatedorgansandstructures.
OverviewoftheDivision
TheDivisionisaclinicallybusyunitthatprovidessurgicalcareforpatientswithallsixcorecompetenciesput
forthbytheAccreditationCouncilofGraduateMedicalEducation.Theseincludecongenitalmalformationsand
acquireddiseasesoftheheart,thorax,trachea,esophagus,andlung.Thisincludesthesurgicaltreatmentof
end‐stagediseaseoftheheartandlungs,includingheart,lungandheart‐lungtransplantationandthe
utilizationofmechanicalcirculatoryassistdevicesbothfortemporaryandpermanenttreatment.TheDivision
alsotreatsmajorthoracictrauma,includingheart,lung,esophagealandgreatvesselinjuries.
LearningObjectives–CoreCompetencies
Professionalism:
1. Todemonstratecompassionandintegritythroughrespectfulpatientcare,familyinteractions,and
communicationwithotherhealthcareproviders.
2. Tounderstandwhenexpertmedicaladviceisnecessary.
3. Toobtainexpertmedical,nursing,orotheropinionswhenlimitsofknowledge,experience,andtraining
arereached.
Interpersonal&CommunicationSkills:
1. Topresentclinicalinformationonworkroundsclearlyandconcisely.
2. Towriteprogressnoteslegiblywithsufficientdetailsothatpatients’condition,statusandcareplansare
clear.
3. Toworkeffectivelywithattendingstaff,housestaffcolleagues,medicalstudents,nurses,ancillary
personnel,pre‐hospitalpersonnel.
4. Tokeepthoracicsurgeryresidentsandattendingstaffinformed,particularlywith“problem”cases,
unstablepatients,andchangesin‐patientconditionandcareplan.
5. Tofosterteamworkandaworkenvironmentbaseduponrespect,trust,andhonesty.
6. Tofosterasocialenvironmentbasedupontoleranceforotheropinions,backgrounds,andcultures.
MedicalKnowledge:
1. Toexpandthefundofknowledgeinthoracicsurgeryfromtextbooks,journals,andelectronicmedia.
2. Tocriticallyevaluatetheliteraturebaseduponmethodologyandstatisticaltechniques,asurveyof
relatedarticles,andresident‐initiateddiscussionswithattendingstaffandotherexperts.
3. Toparticipateinscheduledconferences.
4. Toteachmedicalstudents.
Practice‐BasedLearning&Improvement:
1. Toevaluatepatientscriticallywiththegoalofcomingupwithaworkingdiagnosisandtreatmentplan.
2. Tounderstandthemedical,surgical,andscientificbasesofapatient’sconditionandhisorhertreatment
plan.
3. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,work‐up,orhospitalcourse
whennecessary.
PatientCare:
1. Toknowup‐to‐presentdetailsofallassignedpatients.
2. Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including:
a. Learningtoobtainclinicalinformationfrompatientsandfamilymembers.
b. Obtainingrelevantinformationfromnursesandhospitaldepartments(e.g.,radiology,laboratory,
andhospitalinformationsystems).
c. Obtaininginformationfromreferringphysiciansandhospitals.
3. Tolearntheprinciplesofpreandpostoperativemanagement,including:
a. Fluidandelectrolytemanagement.
b. Managementofpleuralairandfluidcollections.
c. Pharmacologicalmanagement,includingpainandsedation,antibioticdosingandpharmacology.
d. Recognitionandmanagementofrespiratorydistressandshock.
e. Woundcare.
f. Follow‐upandoutpatientmanagement,includingreferralsandresourcesforsocialwork,
rehabilitationandphysicalmedicine.
4. Toperformbasicclinicalprocedures,including:
a. Primaryclosureofincisions.
b. Managementofopenandinfectedwounds.
c. Intravenouslineplacement.
d. Placementofurinarycatheters.
e. Performanceofthoracentesis.
f. Placementofchesttubes.
Systems‐BasedPractice:
1. Toeffectivelytransfercarewhendutyhoursarecompleted.
2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.
3. Toapplystandardizedcareplans,andtherationalebehindthem,including:
a. Bowelpreparationprocedures.
b. Preoperativeantibioticregimens.
c. S.B.E.prophylaxis.
d. Tetanusprophylaxis.
e. Universalprecautions.
f. Aseptictechnique.
g. Careofcentrallines.
h. Careofchesttubes.
i. Postoperativefeedingregimens.
4. Toattendcareconferencesonassignedpatients.
5. Towritenoteswithsufficientdetailtosatisfytherequirementsofgovernmentalagencies,healthcare
payerorganizations,including:
a. Admissionhistories,physicalexaminations,andcareplans.
b. Dailyprogressnotes.
c. Dischargesummaries.
DidacticCurriculum
1. WeeklyDivisionpreoperativeconference.
2. WeeklycombinedPediatricCardiologyandThoracicSurgeryconference.
3. WeeklyCardiacCatheterizationConference(withCardiology).
4. WeeklyMultidisciplinaryThoracicOncologyConference.
5. Dailymedicalstudentconferenceasassigned.
6. MonthlyMorbidityandMortalityConference.
7. MonthlyThoracicSurgeryDidacticCurriculumConference.
Evaluation
Attendingstaffevaluatesresidentperformancebaseduponthesixcorecompetenciessummarizedabove.The
thoracicsurgeryresidentsassistintheevaluationofresidents.
PGY1:ANESTHESIA:
Goals
ThegoalsforthePGY1residentrotatingonAnesthesiaprimarilyrelatetojointcareoftheairway.The
residentshouldunderstandtheprocessofadministeringgeneral,localandregionalanesthesiaandshould
appreciatetherisksofanesthesia.Onegoalofthisrotationistoestablishcamaraderiewithacloseserviceto
ourownthatwillhopefullycontinuefortheremainderoftheresidency.Thisisa1monthrotation.
LearningObjectives–CoreCompetencies
Pre‐AnesthesiaEvaluation:
A. Therotatorshallacquireanappreciationofthepreoperativeevaluationofthesurgicalpatient.Thisis
demonstratedby:
1.
2.
Conductingseveralpreanestheticassessments,including:
a. Takingandrecordingapertinenthistory
b. Performinganappropriatephysicalexamination,includingassessmentof:
i.
Airway
ii. Cardiovascularsystem
iii. Respiratorysystem
c.
Reviewingpertinentlaboratorydata
d. AssigningappropriateASAphysicalstatus
Discussinghowthefollowingfactorsmayinfluencethepatient’scourseduringtheperioperative
period:
a. Age
b. Natureofsurgery,includingelectiveversusemergency
c.
Cardiovasculardisorders,includingbutnotlimitedto:
i.
Anginapectoris
ii. Recentmyocardialinfarction
iii. Congestiveheartfailure
iv. Hypertension
v. Dysrhythmia
d. Respiratorydisorders
i.
Upperand/orlowerrespiratoryinfection
ii. Chronicobstructivepulmonarydisease
iii. Asthma
iv. Obstructivesleepapnea
v. PFTsandbloodgases
vi. Knownorsuspecteddifficultintubation
e. Centralnervoussystemdisorders
i.
Headtrauma
ii. Seizuredisorders
iii. Strokes
iv. Quadriplegiaorparaplegia
v. Increasedintracranialpressure
f.
Gastrointestinaldisorders
i.
Gastroesophagealreflux
ii. Bowelobstruction
iii. Othersituationsassociatedwithafullstomach
iv. Hepatitis,hepaticinsufficiency,portalhypertension
g. Genitourinarydisorders
i.
Renalinsufficiency
ii. Dialysisdependency
h. Hematologicaldisorders
i.
Anemia
ii. Sicklecelltraitordisease
iii. Coagulopathies
i.
Personalorfamilyhistoryofunusualresponsetoanesthesia
i.
Malignanthyperthermia
ii. Abnormalsuccinylcholinemetabolism
iii. Unexplainedpostoperativefeverorjaundice
j.
Lifestylefactors
i.
Smoking
ii. Obesity
iii. Substanceabuse
k. Pregnancy
i.
Fetaldevelopment,teratogenesis
ii. Hypertensivedisorders,pre‐eclampsia
iii. Prematurelabor
3. Medicationhistoriesandtheinfluenceofchronicandcurrent
medicationsontheperioperativeperiod,including:
a. Whichdrugsshouldbecontinuedordiscontinued
b. Thereboundphenomenaresultingfromabruptdiscontinuationofsomeclassesofdrugs,
notablybetablockersandclonidine
c.
Perioperativeglucosecontrol
d. Perioperativemanagementofpatientsonanticoagulants
4. Demonstratingunderstandingofinformedconsent,including:
a. Explanationofriskandalternatives
b. Whenapatientiscapableofgivingconsent,andwhenitmaybeinvalid
c.
Dilemmaswhichmaybeencounteredintheconscientiouspursuitofinformedconsent
Pre‐OperativeMedication:
A. Therotatorshalldemonstrateknowledgeoftheprinciplesofeffectivepre‐anesthesiamedicationby
statingtheobjectivesforuseofdrugsfor:
1.
Narcotics
a. Fentanyl
b. Morphine
2.
Sedatives
a. Benzodiazepines
b. Barbiturates
c.
Propofol
d. Alphaagonists:Clonidine,Dexmedetomidine
3.
Anticholinergics
a. Atropine
b. Glycopyrrolate
c.
Scopolamine
4.
Drugsusedtoreducetheincidenceofconsequencesofpulmonaryaspiration
a. H2antagonists
b. Metoclopramide
c.
Antacids
TheOperatingRoom:
A. Rotatorwillprescribeandconductappropriateintraoperativefluidandelectrolytetherapywiththe
guidanceofhisinstructor:
1.
Explainingtherationalesforestablishingbothcentralandperipheralvenousaccess
2.
Identifyingthecommonsitesforvenousaccessandthecontraindicationsandindicationsforeach
B.
C.
D.
3.
Demonstratingskillatestablishingvenousaccessby:
a. Usingsteriletechnique
b. Successfullyinsertingseveralperipheralcathetersofvariouscalibers
c.
Protectingthevenipuncturesiteandimmobilizingthecatheter
4.
Prescribingmaintenancefluidandelectrolytes
a. Predictinghowthevariousconditionswillalterrequirementsforperioperativemaintenance
therapy
b. Discussingintraoperativeconsiderationswhichaltermaintenancefluidandelectrolyte
therapyincluding:
i.
Bloodloss
ii. Insensibleloss
iii. “Thirdspace”loss
c.
Correctlyinterpretingdatafromthefollowingmonitorsofvolumestatus:
i.
Examinationofthepatient
ii. Vitalsigns
iii. Urineoutput
d. Discussingindications,risks,andbenefitsofcrystalloid,colloid,andbloodproduct replacementtherapies
i.
Regardingthefunctionsof
‐
Bloodvolume
‐
Oxygencarryingcapacity
‐
Coagulation
‐
Immunity
Inordertodemonstrateunderstandingoftheprinciplesandpracticeofroutineintraoperative
monitoring,therotatorwill:
1.
ExplainanddemonstrateECGleadplacementandselectioninoptimizingdetectionof
dysrhythmiasandischemia
2.
Compareandcontrasttheinterpretationofdataobtainedbyvariousnon‐invasiveandinvasive
methodsformonitoringbloodpressure
3.
Demonstrateresultsofarterialbloodgasanalysisintermsof
a. Oxyhemoglobindissociationcurve
b. Shuntfraction
c.
Ventilation‐perfusionmismatch
d. Acid‐basestatus
Therotatorshallcorrectlypositionandpadthepatientinordertoprotecthimfrominjurywhileheis
unconscious
Therotatorwilldemonstrateproperairwayandventilatorymanagementby:
1.
Describingtheindications,risksandbenefitsofairwaymanagementbymaskvs.laryngealmask
airway(LMA)vs.endotrachealintubation(ETT)
2.
Identifyingandstatingtheindicationsforuseof:
a. Curvedandstraightbladelaryngoscopes
b. Oralandnasalairways
3.
Describingandidentifyingbasicoropharyngealandlaryngotrachealanatomy
4.
Identifyingandovercomingupperairwayobstructionwithmaskventilation,using:
a. Properpositioningofthepatient
b. Jawthrust
E.
F.
c.
Nasopharyngealairway
d. Oropharyngealairway
5.
Successfullyintubatingseveralpatientsandidentifyingendotrachealvs.esophagealintubation.
6.
Recognizinganddiscussingtheneedformechanicalventilation.
7.
Comparingandcontrastingthevariousmethodsofmonitoringforadequacyofventilation
8.
Predictingprobableneedforcontinuedventilatorysupport,using:
a. Bloodgasanalysis
b. Respiratoryrateandtidalvolume
c.
Inspiratorypressure
d. Vitalcapacity
e. Shuntfraction
9.
Prescribingappropriateparametersformechanicalventilation
10. Describingandcorrectlyidentifyingindicationsforextubation
Therotatorwilldemonstrateknowledgeofproceduresandpracticeinductionofanesthesia:
1.
Discussingtheindications,contraindications,risksandbenefitsofthefollowinginductionof
anesthesia.
2.
Describingandidentifyingindicationsforrapidsequenceinductionanddiscussingappropriate
techniques.
Therotatorwilldiscussintraoperativemethodsofrecognizingandtreatingvariouscardiovascular
problems,including:
1.
Hypertension
2.
Hypotension
3.
Dysrhythmias
PGY1:EMERGENCYMEDICINE:
Goals
Understandtheemergencyroomaspartofthelargersystemofhealthcaredelivery.Specifically,theemergent
presentationofairwaydisorders,bleedingorcardiacproblemsshouldbeunderstood.Thisisa1month
rotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Developpersonaltechniquesforstressmanagement,physicalandmentalhealth,andcriticalincident
stressdebriefingthatwillpromotewellnessandcareerlongevity.
Interpersonal&CommunicationSkills:
1. Useconsultantsinatimelyandprofessionalmannerforcriticallyillpatients.
2. Developtheabilitytoeffectivelyuseavailableresourcesincludingtraditionalreferences,on‐line
databases,medicalliteraturedatabasesandspecialtyconsultants,inordertoidentifyandinstitutethe
mostappropriatemanagementforindividualpatients.
MedicalKnowledge:
1. SolidifythefollowingclinicalframeworktobeusedinapproachingallEDpatients:
a. Identifypotentiallife,limb,andorganthreats.
b. Stabilizesuchpotentiallife,limb,ororganthreatsusingacquiredskillincertaincriticalprocedures.
c. Learnknowledgeofairwaymanagementofthecriticalairway.
d. Learndispositionofpatientswithappropriateregardtopatienteducation,advocacy,risk
managementandfollow‐up.
Practice‐BasedLearning&Improvement:
1. UnderstandandappropriatelyfollowtheEMTALAlegislationwithregardtoEmergencyRoomCare.
PatientCare:
1. Masterrecognitionandmanagementoflife‐,limb‐,andorgan‐threateningdiseasesandinjuriesin
patientsofallages
Systems‐BasedPractice:
1. Utilizeappropriatediagnosticstudiesinatime‐andcost‐effectivemanner.
PGY1:OTOLARYNGOLOGY:
Goals
Astructured3monthOtolaryngologyexperienceoccursduringthePGY1yearforeachresident.Thisrotation
emphasizesthework‐upandperi‐operativemanagementofsurgicalOtolaryngologypatientsacrosstheentire
spectrumofthefield.PGY1residentsparticipateinclinicalOtolaryngologyrounds,managefloorandICU
patientsandtakeshadow‐callwithjuniorresidents(PGY2and3).Theyarealsointroducedtooperative
Otolaryngologyatapreliminarylevel.
LearningObjectives–CoreCompetencies
Professionalism:
1. PGY1residentsareanticipatedtoparticipateinallaspectsofclinicalcareincludingthepatient
notificationofdiagnoseswiththeaccompanyingpost‐notificationconsultation.Supervisionisprovided
insuchendeavorsbothbythechiefresidentofthespecificserviceaswellastheassociatedattending
physician.
Interpersonal&CommunicationSkills:
1. Residentscommunicateonadailybasiswithpatientsinthepre‐operativeprocessaswellasinteracting
withpatientsontheinpatientOtolaryngologyward.Theyarealsoanticipatedtocommunicateina
timelyandefficientmannerwithattendingsurgeonsregardingproblemsorunanticipateddetails
arisingduringthepre‐operativework‐upprocess.
MedicalKnowledge:
1. PGY1residentsparticipatefullyinthedepartmentalcurriculumduringtheirtimeonservice.This
includesregulartopicallectures,journalclubs,grandrounds,visitingprofessorandanatomy
dissections/demonstrations.
Practice‐basedLearning&Improvement:
1. ThePGY1residentisintendedtogainexperienceandknowledgebyperformingthepre‐operative
evaluationandexaminationofOtolaryngologypatientswithknowndiagnoses.Continuousfeedbackis
offeredbyattending physiciansregardingthedetailsofthework‐upprocess.Residentsare
anticipatedtoanswerpatientquestionswithinthelimitsoftheirknowledgebaseregardingspecificperi‐
operativeproceduraldetails.Theirknowledgeisaugmentedbysittinginonpre‐operativeconsultations
betweentheattendingphysicianandtheirpatients.
Patientcare:
1. PGY1residentsparticipateinOtolaryngologywardrounds,managefloorandICUpatientsandtake
“shadow‐call”withjuniorresidents.Duringthistimeresidentsshouldprovidecompassionate,
appropriateandeffectivecareforthetreatmentofhealthproblemsencounteredbothontheinpatient
hospitalwards,intheEmergencyDepartment,andinthepre‐operativeclinicsetting.PGY1residents
participatebothasanassistanttothesurgicalteamonlargerheadandneckoncologycasesandas
primarysurgeononsupervised(level‐appropriate)surgicalcases.
Systems‐BasedPractice:
1. PGY1residentswilllearntooperateefficientlywithinthecontextofthelargerhospitalsystemasthe
primaryliaisonbetweentheOtolaryngologyserviceandotherassociatedservicesincluding:Nutrition,
SocialServices,RehabilitationServices,andtheCorelaboratoryservices.
RESEARCH
PGY2:RESEARCH
Goals
Astructuredresearchexperience(6months)foreachresidentoccursduringthePGY2year.Thisrotation
emphasizesanunderstandingofthebasicprinciplesofstudydesign,performance,analysis,andreporting.The
researchexperiencemaybeclinicalorbasicinnature,andwillbeundertheadvicebyandplanningofa
qualifiedfacultymember.
LearningObjectives–CoreCompetencies
Professionalism:
1. ResidentsaretoattendethicsinresearchseminarsofferedbytheTranslationalandClinicalSciences
Instituteorthegraduateeducationofficeasthesemaybeavailable.Residentsarealsomentoredonthe
professionalpresentationoftheirresearchresults.
Interpersonal&CommunicationSkills:
1. Residentscommunicateonadailyorbiweeklybasiswiththeirfacultymentortodiscussobstaclesand
solutionsencounteredduringexperiments.Thisrepresentsaneffectiveexchangeofinformationand
collaborationwithhealthprofessionals.
MedicalKnowledge:
1. ResidentsreviewanOtolaryngologytextbookwithafacultymemberonaweeklybasis.Thisactivity
helpsresidentstoestablishafoundationofbiomedicalandclinicalknowledge,aswellastheapplication
ofthisknowledgetopatientcare.Residentsarealsotoattendgrantwritingseminarsofferbythe
TranslationalandClinicalSciencesInstitute.
Practice‐BasedLearning&Improvement:
1. Residentsthroughtheirresearchprojectbegintocriticallyappraisalandassimilationofscientific
evidenceforthepurposesofgrantwriting,manuscriptpreparation,andtoultimatelyimproveinpatient
care.Residents areexpectedtoproduce2manuscriptsandpresentresultsofresearchatnational
meetings.
Patientcare:
1. Duringtheresearchblockresidentscovercalldutiesnomorethaneveryfourthnightbeginningat5pm
onweeknights.Duringthistimeresidents shouldprovidecompassionate,appropriate,andeffective
careforthetreatmentofhealthproblemsencounteredwhileconsultingfortheDepartmentof
Otolaryngology.
Systems‐BasedPractice:
1. Researchmayinvolveprojectsthatdemonstrateanawarenessofandresponsivenesstothelarger
contextandsystemofhealthcare,aswellastheabilitytocalleffectivelyonotherresourcesinthesystem
toprovideoptimalhealthcare.
T‐32RESEARCH
T32:RESEARCH
Goals
Astructuredresearchexperience(2yrs)occursbetweenthePGY‐1andPGY‐2clinicalyears.Thisrotation
emphasizesanunderstandingofmoreadvancedprinciplesofstudydesign,performance,analysis,and
reporting.Theprimaryresearchexperienceisbasicortranslationalinnature,andwillbeundertheadviceby
andplanningofDr.Manis.Additionalclinicalprojectsareencouragedandarecarriedoutundertheguidance
ofaqualifiedfacultymember.
LearningObjectives–CoreCompetencies
Professionalism:
1. ResidentsaretoattendethicsinresearchseminarsofferedbytheTranslationalandClinicalSciences
Instituteorthegraduateeducationofficeasthesemaybeavailable.Residentsarealsomentoredonthe
professionalpresentationoftheirresearchresults.
Interpersonal&CommunicationSkills:
1. Residentscommunicateonadailyorbiweeklybasiswiththeirfacultymentortodiscussobstaclesand
solutionsencounteredduringexperiments.Thisrepresentsaneffectiveexchangeofinformationand
collaborationwithhealthprofessionals.
MedicalKnowledge:
1. ResidentsreviewanOtolaryngologytextbookwithafacultymemberonaweeklybasis.Thisactivity
helpsresidentstoestablishafoundationofbiomedicalandclinicalknowledge,aswellastheapplication
ofthisknowledgetopatientcare.Residentsarealsotoattendgrantwritingseminarsofferbythe
TranslationalandClinicalSciencesInstitute.
Practice‐BasedLearning&Improvement:
1. Residentsthroughtheirresearchprojectbegintocriticallyappraisalandassimilationofscientific
evidenceforthepurposesofgrantwriting,manuscriptpreparation,andtoultimatelyimproveinpatient
care.Residents areexpectedtoproduce2manuscriptsandpresentresultsofresearchatnational
meetings.
Patientcare:
1. Duringtheresearchblockresidentscovercalldutiesnomorethaneveryfourthnightbeginningat5pm
onweeknights.Duringthistimeresidents shouldprovidecompassionate,appropriate,andeffective
careforthetreatmentofhealthproblemsencounteredwhileconsultingfortheDepartmentof
Otolaryngology.
Systems‐BasedPractice:
1. Researchmayinvolveprojectsthatdemonstrateanawarenessofandresponsivenesstothelarger
contextandsystemofhealthcare,aswellastheabilitytocalleffectivelyonotherresourcesinthesystem
toprovideoptimalhealthcare.
WAKEMEDICALCENTER
MICHAELFERGUSON,MD–ASSOCIATEPROGRAMDIRECTOR,WAKEMED
DRS.BLOEDON,DORFMAN,FERGUSON,MARSHALL
PGY2:INTRODUCTIONTOCLINICALGENERALOTOLARYNGOLOGY
Goals:
TheprimarygoalsfortherotationatWakeMedwouldbeforthePGY2residenttoobtainclinicalexperiencein
abusyregionalhospital.Thisisa6monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Dressinappropriateclinicattirewithacleanlabcoat.
2. Respectgenderandculture.
3. Interactwithstaffandnursesinacourteousmanner.
Interpersonal&CommunicationSkills:
1. Effectivelycommunicatefindingsandtreatmentplanswithconsultingphysiciansandteams.
2. Developapositiverelationshipwithreferringandconsultingphysicians.
3. Keeptheattendingotolaryngologyphysicianinformedofallnewandongoingconsults.
MedicalKnowledge:
1. ReadgeneralOtolaryngologytextsuchasKJLeeoreMedicine.
2. Acquirebasicscienceandclinicalknowledgeofgeneralotolaryngology.
3. Understandthefacialskeleton.
4. Discusstheprinciplesofcareinthetreatmentoffacialfractures.
5. AcquiregeneralknowledgetomanagecommonERandinpatientotolaryngologyconsults.
Practice‐BasedLearning&Improvement:
1. Incorporateevaluationandfeedbackintodailypractice.
2. Performselfevaluationtoidentifyareasofweaknessandstrength.
PatientCare:
1. Clinic/consults:
a. Demonstratecompleteheadandneckexam.
b. Obtaindetailedpertinenthistory.
c.
Presentpatientssuccinctlytotheattending.
d. Formulatewell‐thoughouttreatmentplan.
e. Bedsideevaluationoftheairway.
f.
CommonERcalls–epistaxis,PTA,softtissuelacerationsetc.
g. Evaluateandformulateplanforesophagealforeignbodies.
h. Evaluatecommonfacialtrauma–mandible,midface,orbitalfloorfractures.
2. Surgicalskills:
a. Laryngoscopy.
b. Nasalendoscopy.
c.
Tonsillectomyandadenoidectomy.
d. MyringotomyandplacementofPEtubes.
e. Excisionofsimpleskincystsandlesions.
f.
Excisionalbiopsyofsuperficialanddeepcervicallymphnodes.
g. Incisionanddrainageofdeepneckabscess.
h. Intermaxillaryfixationofthefacialskeleton.
i.
ORIFofsimplefacialfractures–mandibleandzygoma.
j.
Panendoscopy.
k. Esophagoscopywithforeignbodyremoval.
l.
Closureofcomplexfaciallacerations.
m. Nasalendoscopywithcautery.
n. Removalofnasalandearforeignbodies.
o. Fineneedleaspirationofheadandneckmasses.
p. Incisionanddrainageoffacialandneckabscesses.
q. Adulttracheostomy.
Systems‐BasedPractice:
1. Understandhowtypesofmedicalpracticeanddeliverysystemsdifferfromoneanother.
2. Investigatemethodsofcontrollinghealthcarecosts.
3. Advocateforqualitypatientcare.
PGY3:GENERALOTOLARYNGOLOGYWITHCLINICALFOCUS(RHINOLOGY,FACIALPLASTICSANDOTOLOGY
Goals
TheprimarygoalsforthePGY3residentatWakeMedwouldbetoexpandtheirclinicalexperienceataregional
hospitalwiththespecificgoalsofenhancingthetraumaexperience,understandingadifferentsystemof
practicethananacademichealthcenter,andfurtheringtheiroperativeexperienceinawiderangeof
otolaryngologicprocedures.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Understandprofessionalismasthebasisformedicine’scontractwithsociety.
2. Wearappropriateclinicattire.
3. Treatotherteamswithrespect.
Interpersonal&CommunicationSkills:
1. Demonstrateactivelisteningwhileinterviewingnewpatients.
2. Keepattendinginformedofallinpatients.
3. Communicatepatienttreatmentplanswithnursesandancillarystaff.
MedicalKnowledge:
1. Earandtemporalboneanatomy.
2. Auditoryandvestibularphysiology.
3. TemporalboneCTanatomy.
4. Interpretaudiograms,tympanometry,OAE,ABR,reflexes.
5. MasterCToffacialfractures.
6. Reconstructionladderforheadandneckcutaneousdefects.
7. Sinonasalanatomyonendoscopy.
8. SinonasalanatomyonCT.
9. Understandallergytestingandresultsinterpretation.
10. Differentiateviral,bacterial,fungal,allergic,structuralsinusitis.
11. UnderstandcontributionofGERD,migraine,psychologicalissuesastheyrelatetosinonasalcomplaints.
Practice‐BasedLearning&Improvement:
1. Acceptcriticism–usetoimprove.
2. Recognizeskillareasthatneedadditionalfocus.
3. Learntoreadliteraturecritically.
Patientcare:
1. Clinic/consults:
a. Chronicsinuspatients.
b. Allergyandnasalobstruction
c.
Chroniceardisease.
d. Evaluatepatientscomplainingofhearingloss,tinnitus,dizziness,orfacialweakness.
e. Identifyanormaltympanicmembraneandcommonpathologyincludingotitisexterna,serous
otitismedia,tympanicmembraneperforationandcholesteatoma–usemicroscopy.
f.
Diagnosticsinonasalendoscopy.
g. Placementofearwicks,eardebridement.
h. Temporalbonetrauma.
i.
Bonyfacialtrauma.
j.
Airwayemergency.
k. Managementofepistaxis.
2. SurgicalSkills:
a. Tympanoplasty.
b. Mastoidectomy.
c.
FESS.
d. Myringotomyandtubes–inanawakeadult.
e. Septoplasty.
f.
SMRturbinates. g. Midfacefractures,orbitalfloorfractures,ZMCfractures.
h. Introductiontothyroidectomy,parotidectomy.
i.
Pediatricneckabscess.
j.
Congenitalpediatricneckmasses.
k. Rhinoplasty.
l.
Reconstructionofskindefects–localflaps,skingrafting.
m. Adulttracheostomy‐leadingamorejuniorresident.
Systems‐BasedPractice:
1. Assistpatientsindealingwithsystemcomplexities.
PGY4:SERVICECHIEFRESIDENT–HEAD&NECKCANCERFOCUS
Goals
TheprimarygoalfortheservicechiefresidentatWakeMedistoperforminaleadershiproleatabusyregional
hospital.Theservicechief,inadditiontoperformingmorecomplexsurgeries,hastheultimateresponsibility
forcoordinatingschedules,communicatingwithjuniorresidentsandattendings,andrepresentingtheservice
toothersinthelargercontext.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Learntorespectandseekoutpatientsownwishesabouttheircare.
2. Actinanaltruisticmannerwithpatientsandcolleagues.
Interpersonal&CommunicationSkills:
1. Practiceappropriateinteractionswithreferringphysicians,juniorandsenior residentsandattendings.
2. Understandtheimportanceofdirectcommunicationwithcommunityphysicians.
3. FacilitateanamicableworkingrelationshipwiththeERphysicians.
4. Communicatedailyplanwithjuniorresidents.
MedicalKnowledge:
1. Thoroughknowledgeofheadandneckanatomy.
2. Usemodernimagingtoinvestigateandformulatetreatmentplanforheadandnecktumors.
3. Understandandemployalternativeadjuvanttherapy–radiationandchemotherapyinthetreatmentof
HeadandNecktumors.
4. Properlystageheadandnecktumors.
5. Knowlistofthyroidneoplasmsandbestcourseoftreatmentforeach.
6. Understandcommonsalivaryneoplasmsandbestcourseoftreatmentforeach.
7. Understandpotentialcomplicationsofcancersurgery–andwaystomanagethese.
8. Knowvariousreconstructivemethods–skingrafts,localflaps,regionalflaps,freeflaps.
Practice‐BasedLearning&Improvement:
1. Applyliteratureandstudiestoownclinicalpractices.
2. Readcritically.
3. Identifyownstrengthsandweaknesses–aswellasoperativedeficiencies.
4. Setlearningandskillsgoals.
5. Facilitatelearningofjuniorresidents.
PatientCare:
1. Clinic/consults:
a. Headandneckcancerpatients.
b. Thyroidandsalivaryneoplasms.
c.
Airwayemergency.
d. Neckandfacialtrauma.
2. SurgicalSkills:
a. Showcompetencyintheoperatingroom.
b. Panendoscopy.
c.
Widelocalexcisionofaerodigestivetractmalignancies.
d. Splitthicknessskingraft.
e. Marginalandsegmentalmandibulectomy.
f.
Laryngectomy.
g. Neckdissection.
h. Thyroidectomy.
i.
Parotidectomy.
j.
Managementofdifficultairway.
k. Removalofairwayforeignbody.
l.
Pan‐facialfractures‐bicoronalapproach.
m. Leadingajuniorresidentthroughanadulttracheostomy.
Systems‐BasedPractice:
1. Understandhealthcarecosts.
2. Understandhowourpatientcareimpactsotherhealthcareproviders.
PEDIATRICS/OTOLOGY
DRS.DRAKE,ROSE,ZDANSKI/DRS.ADUNKA,BUCHMAN,PILLSBURY
PGY3:PEDIATRICS/OTOLOGY(PO)
Goals
TheprimarygoalsforthePGY3residentonthisrotationaretoappreciatethatthecareoftheinfantandchild
differsfromthatofanadult,tolearnanatomyrelevanttothetemporalbone,andtolearnthejudgment
involvedinpracticingspecialtyotolaryngologiccare.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
2. Learnsandpracticesethicalbehaviorinthetreatmentofpediatricpatient.
3. Activelyobserveandparticipateinthecareoftheprematureinfant.
4. Learntomanageallaspectsofpediatricsensorineuralhearingloss
InterpersonalandCommunicationSkills:
1. Practiceempatheticlisteningskills.
2. Practiceprofessionalinteractionswithreferringphysicians,fellowresidents,attendings,nursingand
operatingroomstaff.
3. Practiceappropriateinteractionswithmultispecialtycolleaguesduringon‐calltimes.
MedicalKnowledge:
1. Understandindicationsforcommonsurgicalprocedures,includingpressure‐equalizationtubes,
tonsillectomyandadenoidectomyandtheircomplications,includingtympanicmembraneperforation,
bleedingandvelopharyngealinsufficiency.
2. Perioperativecareincludingfluidandelectrolytephysiologyandpainmanagement.
3. Basicaudiologyandinterpretationofhearingtesting.
Practice‐BasedLearning&Improvement:
1. Participateincadaverdissectionsyearlyincorporatingprincipleslearnedfromdidacticsessions.
2. Examineownoperativelistandobtainadditionaltrainingwhennecessary.
3. Considerthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.
PatientCare:
1. Endoscopictechniquesincludinglaryngoscopy,bronchoscopyandesophagoscopy,usingmagnification
viamicroscopes,telescopes,bronchoscopes.
a. Tonsillectomy/adenoidectomytechniques.
b. Infant/childtracheostomytechniques.
c.
Operativeplacementofpressure‐equalizingtubes.
d. Surgicalprocedurestoclosetympanicmembraneperforations.
e. Mastoidectomy(asastandaloneoraccessprocedure).
f.
Approachestothemiddleearandlateralportionofthetemporalbone.
Systems‐BasedPractice:
1. LearnandparticipateinthemonthlyMorbidityandMortalityconference.
2. ParticipateincodingandbillingprocessesforboththeclinicandOR.
3. Understandtheissuesrelatingtodrugprescriptions,includingpediatricdosingandallergies.
4. Learntomanagesystemsbasedcareofinfantsandchildrenwithtracheostomiesandotherairway
problems.
5. Learntomanagesystemsbasedcareofinfantsandchildrenwithsensorineuralhearingloss.
PGY4:PEDIATRICS/OTOLOGY(PO)
Goals
ThegoalsofthePGY4rotationaretoimprovetheunderstandingoftheairwayandotologiccareofpatients
andtoimprovesurgicalskillinthesetwoareas.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Addresspatientandpatients’familieswithrespecttotheircultureandgender.
2. Learnandpracticeethicalbehaviorinthetreatmentofpediatricpatientswithcommunicationbarriers
suchastracheostomies,hearingimpairedpatients,andpediatrictumorpatients.
3. Activelyconsiderandreadaboutcareoftheprematureinfant.
Interpersonal&CommunicationSkills:
1. Communicatethroughaninterpreter,especiallypreoperativecounselingforaprocedure,with
discussionofrisks,benefitsandalternativeprocedures.
MedicalKnowledge:
1. Observeandunderstandbasiclasertechnology.
2. Understandthework‐upandtreatmentofabnormalitiesofspeechandswallow,including
velopharyngealdysfunction,apraxiaofspeechandaspiration.
Practice‐BasedLearning&Improvement:
1. Participateincadaverdissectionsyearlyincorporatingprincipleslearnedfromdidacticsessions.
2. ParticipateinthemonthlyMorbidityandMortalityconferenceandusetheexperiencetodirect
additionalreadingontimelytopics.
3. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.
4. Considerthecost‐benefitanalysisofvarioustypesoftonsillectomytechniques,includingcoblation,
powered‐instrumentation,andcoldsteel.
PatientCare:
1. Participateintympanoplasty,mastoidectomyandplacementofacochlearimplant.
2. Understandtheprinciplesandparticipateintympanomastoidsurgeryforchronicotitismediawith
cholesteatoma.
3. Understandthebasicprinciplesofcerebellopontineanglelesionmanagement.
4. Understandtheresectionofcongenitalneckmasses,vascularmalformations,andotherpediatrichead
andneckneoplasms.
5. Understandthemedicaltreatmentoptionsforinfectionsoftheheadandneck,includingmastoiditis,
neckinfectionsandsinusitis.
6. Observeandunderstandthemedicalandaudiologicwork‐upofapediatricpatientforcochlear
implantationincludingathoroughunderstandingandlimitationsofelectrophysiologicobjective
audiometrictestingsuchasABRandOAE’s.
Systems‐BasedPractice:
1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.
PGY5:PEDIATRICS/OTOLOGY(PO)
Goals
Goalsforthechiefresidentonthisrotationinclude“running”theservice,coordinatingworkforceissues,call
andinterfacingwiththeotherchiefsonotherOTO‐HNSservices.Inadditiontotheleadershiprole,thePGY5
hasthegoalofunderstandingthecareofcomplexearandairwaypathologyandtheskilltoaccomplishthe
moredemandingsurgicalcasesinthesespecialtyareas.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Addresspatientandpatients’familieswithrespecttotheirculture,genderanddisability.
2. LearnandpracticeethicalbehaviorintheORandclinic,withattentionpaidtothevariousmembersof
thehealthcareteam.
3. Counselateenaboutblood‐borneorsexually‐transmittedillness.
Interpersonal&CommunicationSkills:
1. Contemplatetheparentingofamedicallyfragilechild.
2. Participateinaparentconferenceregardingtheplacementofatracheostomy,ventilator,implantor
othermedicaldevice.
3. Participateinendoflifediscussionswithcare‐giversofchildrenwithendstageorterminaldisease.
MedicalKnowledge:
1. Appreciatethemanifestationsofcongenitalsyndromesinvolvingtheheadandneck,includingbranchio‐
oto‐renal,velocardiofacialsyndrome,CHARGEassociation,Treacher‐Collins,PierreRobinsequence.
2. ParticipateinadvancedimageinterpretationoftemporalboneandheadandneckCTscans,MRI’sand
BrainLabimagingofthesinuses.
3. Understandthegeneticsofhearingloss.
Practice‐BasedLearning&Improvement:
1. ParticipateinM&Mconferencesandsuggestimprovementsinhealthcaredeliverywhenappropriate.
2. Recognizetheroleofthefosterfamilyandguardianshipofasickchildwhenitisneeded,aswellaswhen
tousesocialservicestoinvestigatetheneedsofa compromisedpatient.
PatientCare:
1. Advancedapproachesinthetemporalboneincludingneurotologicsurgeriesandproceduresofthe
lateralskullbase.
2. Advancedpediatricairwayprocedures,includinglaryngotrachealreconstructionandcricotracheal
resection.
3. Advancedendoscopicairwayapproaches,includingsupraglottoplasty,repairoflaryngealclefts,and
ablativetechniquesforairwayobstructionsecondarytoneoplasm.
Systems‐BasedPractice:
1. RecognizetheroleoftheCCCDPinmanagementofpediatricsensorineuralhearingloss.
2. ParticipateinthemultidisciplinarycareofthepediatrictracheostomyandairwaypatientsviatheNorth
CarolinaChildren’sAirwayCenter.
3. Recognizetheinterdisciplinarypositionoftheneurotologistinthecareoflateralskullbasedisorders.
HEAD&NECK/FACIALPLASTICS
DRS.HACKMAN,SHORES,WEISSLER/DR.SHOCKLEY
PGY3:HEAD&NECK/FACIALPLASTICS(HF)
Goals
ThegoalsofthePGY3rotationonthisrotationaretobegintounderstandthediagnosisandmultidisciplinary
treatmentofheadandnecktumors.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Completetheintroductorymaterialandthefirst3vignettesof“ProfessionalisminSurgery:Challenges
andChoices”DVD.
2. ReadGruenRL,AryaJ,CosgroveEM,CruessRL,CruessSR,EastmanAB,FabriRJ,FriedmanP,KirkseyTD,
KodnerIJ,LewisFR,LiscumKR,OrganCH,RosenfeldJC,RussellTR,SachdevaAK,ZookEG,HarkenAH;
AmericanCollegeofSurgeonsTaskFroceonProfessionalism.JAmCollSurg.2003Oct;197(4):605‐8.
3. ReadACSTaskForceonProfessionalism.JAmCollSurg.2004Nov;199(5):734‐5.
4. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
5. Learnsandpracticesethicalbehaviorinthetreatmentofheadandneckcancerpatientsincorporating
theconceptsofbeneficence,non‐maleficence,patientautonomyintodailypractice.
6. Activelyconsiderandreadaboutpalliativeandendoflifecare.
Interpersonal&CommunicationSkills:
1. Practiceactivelisteningwhileinterviewingnewpatients.
2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresidents,
attendings,nursingandoperatingroomstaff.
3. Practiceappropriateinteractionswithmultispecialtycolleaguesinaheadandnecktumorboard.
MedicalKnowledge:
1. Headandneckanatomy.
2. Perioperativecareincludingfluidandelectrolytephysiologyofthesurgical
patient.
3. Perioperativepainmanagement.
Practice‐BasedLearning&Improvement:
1. ParticipateinHeadandNeckcadaverdissectionsyearlyincorporatingprincipleslearnedfromdidactic
sessions.
2. Participateintheweeklyheadandnecktumorboardandusetheexperiencetodirectadditionalreading
ontimelytopics.
3. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.
4. Considerthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies
PatientCare:
1. Endoscopytechniquesincludinglaryngoscopy,bronchoscopyandesophagoscopy.
2. Basicsurgicalexposureintheheadandneck.
3. Woundclosuretechniques.
Systems‐BasedPractice:
1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.
2. LearnpropercodingandbillingprocessesforbothclinicandOR.
3. LearntousethevariousaspectsoftheWebCIS,theUNCelectronicmedicalrecord.
PGY4:HEAD&NECK/FACIALPLASTICS(HF)
Goals
ThegoalsforthePGY4residentonthisrotationaretolearnthemultidisciplinarycareoftheheadandneck
cancerpatientinthegreatercontextofhealthcare,aswellastobecomemoreproficientinthesurgeries
requiredtoresectsuchtumors.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Completethe4ththroughthe15thvignettesof“ProfessionalisminSurgery:ChallengesandChoices”
DVD.
2. Listentothe“EthicsandPhilosophyLecture”OnPatientSafetyCDProgramfromtheAmericanCollegeof
Surgeons.
3. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
4. Learnsandpracticesethicalbehaviorinthetreatmentofheadandneckcancerpatientsincorporating
theconceptsofbeneficence,non‐maleficence,patientautonomyintodailypractice.
5. Activelyconsiderandreadaboutpalliativeandendoflifecare.
Interpersonal&CommunicationSkills:
1. Listento“EffectiveCommunication:anEssentialCompetencytoEnhanceSurgicalCare,PromoteSafety,
andReduceLiability”OnPatientSafetyCDProgramfromtheAmericanCollegeofSurgeons.
MedicalKnowledge:
1. Oncogenesis.
2. Basicradiationbiology.
3. Lasertechnology.
Practice‐BasedLearning&Improvement:
1. ParticipateinHeadandNeckcadaverdissectionsyearlyincorporatingprincipleslearnedfromdidactic
sessions.
2. Participateintheweeklyheadandnecktumorboardandusetheexperiencetodirectadditionalreading
ontimelytopics.
3. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.
4. Considerthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.
PatientCare:
1. Submandibularglandresection.
2. Basictransoralapproachestotheoralcavityandtonsillarfossa.
3. Locatethefacialnerveinparotidectomysurgery.
4. Locatetheparathyroidglandsandrecurrentandexternalbranchofthesuperiorlaryngealnervein
thyroidectomysurgery.
5. Blepharoplasty,rhinoplasty,face‐lift.
Systems‐BasedPractice:
1. LearnaboutUNCP&AanditsrelationshipwiththeHealthCareSystem.
2. LearnpropercodingandbillingprocessesforbothclinicandOR.
3. Learntouseadjunctstohealing,suchasproductsdesignedtominimizescar,avoidanceofsunand
exercisetomaintainoptimalresultsincosmeticprocedures.
PGY5:HEAD&NECK/FACIALPLASTICS(HF)
Goals
ThegoalsforthePGY5residentonthisrotationaretobecomeproficientintheextirpationandreconstruction
ofheadandneckcancers,tounderstandendoflifeissues,andtobecomethetypeofsurgeonmostcapableof
deliveringexpertcare.Furthergoalsrelatetodevelopingexpertiseinfacialplasticsurgeryandcosmeticas
wellasfunctionalsurgeryontheface.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Completethe16ththroughthe24thvignettesof“ProfessionalisminSurgery:ChallengesandChoices”
DVD.
2. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
3. Learnsandpracticesethicalbehaviorinthetreatmentofheadandneck cancerpatientsincorporating
theconceptsofbeneficence,non‐maleficence,patientautonomyintodailypractice.
4. Activelyconsiderandreadaboutpalliativeandendoflifecare.
InterpersonalandCommunicationSkills:
1. Listento“TheDisruptiveProfessional”OnPatientSafetyCDProgramfromtheAmericanCollegeof
Surgeons.
MedicalKnowledge:
1. ComplexmultidisciplinarycareoftheH&Ncancerpatient.
2. Advancedimageinterpretation.
3. Pathologyoftheheadandneck.
Practice‐BasedLearning&Improvement:
1. Listento:“TheVolumeandQualityConundrum:WhataretheData”OnPatientSafetyCDProgramfrom
theAmericanCollegeofSurgeons.
2. Listento:“Practice‐BasedLearningandImprovement:anEssentialComponentofMOC”OnPatient
SafetyCDProgramfromtheAmericanCollegeofSurgeons.
PatientCare:
1. Advancedapproaches:mandibulotomy;lateralrhinotomy.
2. Partialandtotallaryngectomy.
3. Thyroidectomy.
4. Parotidectomy.
5. Radicalandselectiveneckdissection.
6. Advancedendoscopicapproaches.
7. Advancedrhinoplasty,vascularizedflaps.
Systems‐BasedPractice:
1. Listento“AccreditationofSurgeryCenterstoOptimizePatientCare”OnPatientSafetyCDProgramfrom
theAmericanCollegeofSurgeons.
2. Listento“ImprovingPatientSafetyintheOperatingRoom”OnPatientSafetyCDProgramfromthe
AmericanCollegeofSurgeons.
CONSULTSERVICECHIEF
PGY5:CONSULTSERVICECHIEFRESPONSIBILITIES
Goals
TheconsultchiefrunstheconsultserviceandinterfaceswiththechiefresidentsontheotherOTO‐HNS
services.Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. PresentasanagreeableportalforacceptanceofconsultsintotheOTO‐HNSservice.
Interpersonal&CommunicationSkills:
1. Makesandcommunicatestheservice/clinicscheduleforthe3monthsblocksincoordinationwiththe
servicechiefs.
2. ResponsibleforsettingupalldidacticsexceptThursPMserviceconference
3. Interactswithattendingphysiciansonallotherservicesifconflictsariseinconsultcare.
MedicalKnowledge:
1. Readsjournalarticlesandtextbookarticlesonconsultcaseswhichpresent.
Practice‐BasedLearning&Improvement:
1. UnderstandEMTALA,Hospice,dischargeplanningtoinstitutionsand/orhome.
PatientCare:
1. Responsibleforrunningroundseverymorning.
Systems‐BasedPractice:
1. Interfacewithotherservicestomaximizeeducationalopportunitiesforeachresident.
PGY3:
Professionalism:
1. Presentinanon‐threatening,conservativefashion.
2. Avoideventconflictwithotherservices.
3. ComplywithHIPAA.
Interpersonal&CommunicationSkills:
1. Interactwithconsultingservicesbyintroductionofselfandexpectationofconsult.
MedicalKnowledge:
1. Participateinconferences.
2. NeedEMTALA.
Patientcare:
1. Assessandpresentallconsultstoseniorresidentand/orattending.
Systems‐BasedPractice:
1. Learnpropercompletionofconsultsincludingcompletionofelectronicmedicalrecords(WebCIS).
RHINOLOGY/LARYNGOLOGY
DRS.EBERT,SENIOR/DRS.BUCKMIRE,ZANATION
PGY3:RHINOLOGY/LARYNGOLOGY(RL)
Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Residentsmustpresentinacleanandprofessionalfashionwithacleanlabcoat.
2. Washeshandsinfrontofpatientandbetweeneachpatientcontact.
3. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
Interpersonal&CommunicationSkills:
1. Practiceactivelisteningwhileinterviewingnewpatients.
2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresidentsand
attendings.
3. Practiceappropriate,professionalinteractionswithmedicalstudentsandvisitinginternational
physicians.
4. Residentdemonstratesproficiencyingatheringandassimilatingdatafromothercollaborative
specialtiesinthemulti‐disciplinaryvoiceandswallowingclinic(GI,SpeechPathology,andNeurology).
Thedataisthenpresentedinanorganizedfashiontotheattendingphysicianofseniorresidentstaffon
service.
MedicalKnowledge(Goals):
1. Tounderstandtheanatomyofthenasalcavity,paranasalsinusesandanteriorskullbaseaswellasits
basicembryology.
2. Tounderstandanddescribetheexpectedoutcomesofmedicalandsurgicalmanagementofchronic
rhinosinusitisandchronicrhinitisandmethodsofassessment.
3.
4.
5.
Torecognizepotentialcomplicationsofendoscopicsinussurgeryandtoknowtheirappropriate
treatment.
Torecognizepotentialcomplicationsofallergytestingandallergyserumadministrationandtoknow
theirappropriatetreatment.
ResidentcompletesthecoredidacticreadingmaterialfortherotationincludingselectedLaryngology
articlesandbookchapters.
Toachievegoals:
a. Readsandcompletesassignmentsindidacticeducationcourse.
(i.e.Readandpresentchapters/articlesfromHomestudyandrhinologytextbook:Kennedy’s
“DiseasesoftheSinuses”)
b. Developunderstandingofsinonasalanatomy/pathologyfromlectures,dissectioncourses(yearly
SouthernStatesRhinologyCourse),aswellasfromOR/clinicexams.AttendResidentAllergy
courseonceduringresidency.Reference:KennedyDW,BolgerW,ZinreichS(eds):Diseasesofthe
Sinuses,DiagnosisandManagement.Hamilton,B.C.Decker,2001.
c. Readthemedicalliteratureandshowanunderstandingoftherelevantrecentliteratureasit
appliestomanagementofallergic,inflammatorysinusdisease,andskullbaseneoplasms.
d. UsePubMed,UptoDateandotherweb‐baseddatabasestolookupinformationoncurrent
patients.
e. Keeptheelectronicmedicalrecorduptodate.
Practice‐BasedLearning&Improvement:
1.
ParticipateinSinusdissectioncourseyearlyincorporatingprincipleslearnedfromdidacticsessions.
2.
Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.
3.
Considerthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.
PatientCare(Goals):
1. Tounderstandtheproperevaluationofthepatientwithsinonasalorallergicdiseaseaswellas,
indicationsforendoscopicsinus/skullbasesurgery.
2. Tounderstandtheevidencebasedmedicalmanagementofthepatientwithsinonasaldisease.
3. Tobecomefamiliarwithbasicendoscopicsurgicalplanningandset‐up.
4. Tounderstandtheadministrationandinterpretationoflaboratorytestsandtoproficientlyevaluate
radiographicimagesoftheparanasalsinuses.
5. Tolearninstrumentsusedforendoscopicsinussurgeryandroutineclinicuse.
6. Todescribethepropertechniquesandstepsinendoscopicsinussurgery:anteriorethmoidectomy,and
middlemeatalantrostomy.
7. Todescribethepropertechniquesforinvitro,skinprick,andintradermalallergytestingandmixingof
patientspecificserum.
8. Residentdemonstratesfacilityinobtainingasub‐specialty(laryngology)focusedhistoryandphysical,
performingofficebasedendoscopy/stroboscopyandcommunicatingaconcisepresentationofthesalient
featurestotheattendingphysician.
Toachievegoals:
a. ActivelyparticipateinoutpatientclinicsandOR’swithattendingsandallergynursingstaff.
b. Independentlyperformcomprehensiveallergyandrhinologichistory,physicalexamination
(includingnasalendoscopywithrigidandflexibletelescopes)andorderingofappropriate
diagnostictestingfortheclinicalproblem.
c.
Makeapresumptivediagnosesandsynthesizeatreatmentplansforclinicandconsultpatients.
Then,presentpatientstotheattendinginanorganizedandmannerforcritique.
d. Learnandapplysurgicalindicationsfortreatmentofsinonasaldiseasebyincorporatinglabtest
andradiographicimagingintodecision‐makingprocess.
e. Followpatientsfromadmissiontodischarge:determiningappropriatetimefordischargeand
follow‐up.
Systems‐BasedPractice:
1.
LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.
2.
DiscussactivelythebuildingofnewhealthcareresourcessuchastheHillsboroughHospitalandits
effectonpatientcareandphysicianlivelihood.
3.
LearnpropercodingandbillingprocessesforbothclinicandOR.
PGY4:RHINOLOGY/LARYNGOLOGY(RL)
Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Residentsmustpresentinacleanandprofessionalfashionwithacleanlabcoat.
2. Washeshandsinfrontofpatientandbetweeneachpatientcontact.
3. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
Interpersonal&CommunicationSkills:
1. Practiceactivelisteningwhileinterviewingnewpatients.
2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresidentsand
attendings.
3. Practiceappropriate,professionalinteractionswithmedicalstudentsandvisitinginternational
physicians.
4. Residentiscapableofmanaginghospital‐based,sub‐specialty(laryngology)consultsfromotherservices,
includingclearcommunicationofthedetailsofthecasetotheattendingphysician.Thereafter,the
residentmanages/arrangesboththecommunicationandcarrying‐outoftheplanwiththeprimaryteam,
includingadditionaltesting,testinterpretationandpotentiallysurgicalintervention.
MedicalKnowledge(Goals):
1. Tounderstandtheanatomyofthenasalcavity,paranasalsinusesandanteriorskullbaseaswellasits
basicembryology.
2. Tounderstandanddescribetheexpectedoutcomesofmedicalandsurgicalmanagementofchronic
rhinosinusitisandchronicrhinitisandmethodsofassessment.
3. Torecognizepotentialcomplicationsofendoscopicsinussurgeryandtoknowtheirappropriate
treatment.
4. Torecognizepotentialcomplicationsofallergytestingandallergyserumadministrationandtoknow
theirappropriatetreatment.
5.
ResidentdemonstratesproficiencyininterpretingFEESswallowingstudies,stroboscopicexaminations
anddevelopsacompetentdifferentialdiagnosisandtreatmentplanforpresentationtotheAttending
physician.
Toachievegoals:
a. Readsandcompletesassignmentsindidacticeducationcourse.,i.e.Readandpresent
chapters/articlesfromHomestudyandrhinologytextbook:Kennedy’s“DiseasesoftheSinuses”.
b. Developunderstandingofsinonasalanatomy/pathologyfromlectures,dissectioncourses(yearly
SouthernStatesRhinologycourse),aswellasfromOR/clinicexams.AttendResidentAllergycourse
onceduringresidency.Reference:KennedyDW,BolgerW,ZinreichS(eds):Diseasesofthe
Sinuses,DiagnosisandManagement.Hamilton,B.C.Decker,2001.
c. Readthemedicalliteratureandshowanunderstandingoftherelevantrecentliteratureasit
appliestomanagementofallergic,inflammatorysinusdisease,andskullbaseneoplasms.
d. UsePubMed,UptoDateandotherweb‐baseddatabasestolookupinformationoncurrentpatients.
e. Keeptheelectronicmedicalrecorduptodate.
Practice‐BasedLearning&Improvement:
1. ParticipateinSinusdissectioncourseyearlyincorporatingprincipleslearnedfromdidacticsessions.
2. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.
3. Considerthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.
PatientCare(Goals):
1. Tounderstandtheproperevaluationofthepatientwithsinonasalorallergicdiseaseaswellas,
indicationsforendoscopicsinus/skullbasesurgery.
2. Tounderstandtheevidencebasedmedicalmanagementofthepatientwithsinonasaldisease.
3. Tobecomeproficientinbasicendoscopicsurgicalplanningandset‐up.
4. Tounderstandtheadministrationandinterpretationoflaboratorytestsandtoproficientlyevaluate
radiographicimagesoftheparanasalsinuses.
5. Tolearnanduseinstrumentsusedforendoscopicsinussurgeryandroutineclinicuse.
6. Todescribeandperformthepropertechniquesandstepsinendoscopicsinussurgery:anterior
ethmoidectomy,andmiddlemeatalantrostomy,completesphenoethmoidectomy,endoscopicandopen
septoplasty,aswellasclinic‐basedpost‐opcare.
7. Toperformthepropertechniquesforinvitro,skinprick,andintradermalallergytestingandmixingof
patientspecificserum.
8. ResidentsisproficientwithbasicLaryngologyoperativetechniquesincludingsuspensionlaryngoscopy,
vocalfoldinjection,microdirectlaryngoscopywithexcisionaswellashavingaworkingknowledgeof
microinstrumentation,laryngoscopeselectionandORroomset‐up.
Toachievegoals:
a.
ActivelyparticipateinoutpatientclinicsandOR’swithattendingsandallergynursingstaff.
b. Independentlyperformcomprehensiveallergyandrhinologichistory,physicalexamination
(includingnasalendoscopywithrigidandflexibletelescopes)andorderingofappropriate
diagnostictestingfortheclinicalproblem.
c. Makeapresumptivediagnosesandsynthesizeatreatmentplansforclinicandconsultpatients.
Then,presentpatientstotheattendinginanorganizedandmannerforcritique.
d.
e.
Learnandapplysurgicalindicationsfortreatmentofsinonasaldiseasebyincorporatinglabtest
andradiographicimagingintodecision‐makingprocess.
Followpatientsfromadmissiontodischarge:determiningappropriatetimefordischargeand
follow‐up.
Systems‐BasedPractice:
1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.
2. DiscussactivelythebuildingofnewhealthcareresourcessuchastheHillsboroughHospitalanditseffect
onpatientcareandphysicianlivelihood.
3. LearnpropercodingandbillingprocessesforbothclinicandOR.
PGY5:RHINOLOGY/LARYNGOLOGY(RL)
Thisisa3monthrotation.
LearningObjectives–CoreCompetencies
Professionalism:
1. Residentsmustpresentinacleanandprofessionalfashionwithacleanlabcoat.
2. Washeshandsinfrontofpatientandbetweeneachpatientcontact.
3. Addressespatientandpatients’familieswithrespecttotheircultureandgender.
Interpersonal&CommunicationSkills:
1. Practiceactivelisteningwhileinterviewingnewpatients.
2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresidentsand
attendings.
3. Practiceappropriate,professionalinteractionswithmedicalstudentsandvisitinginternational
physicians.
4. Residentdiscussesthedetailsofoperativeprocedurewiththepatientincludingrisksbenefits,expected
outcomes,post‐operativerecommendationsandwork‐relateddetails(i.e.Voicerest,returntowork).
Theresidentiscapableofinteractingwiththeschedulingpersonnelandtheancillaryservices(Speech
Pathology)forarrangingtheprocedureandsubsequentpost‐operativecare.
MedicalKnowledge(Goals):
1. Tounderstandtheanatomyofthenasalcavity,paranasalsinusesandanteriorskullbaseaswellasits
basicembryology.
2. Tounderstandanddescribetheexpectedoutcomesofmedicalandsurgicalmanagementofchronic
rhinosinusitisandchronicrhinitisandmethodsofassessment.
3. Torecognizepotentialcomplicationsofendoscopicsinussurgeryandtoknowtheirappropriate
treatment.
4. Torecognizepotentialcomplicationsofallergytestingandallergyserumadministrationandtoknow
theirappropriatetreatment.
5. Residentdemonstratesproficiencyintheinterpretationofvoiceandswallowingwork‐upaswellas
diagnosticstudies,andcanplanandarticulateanoperativeplanincludingrisksbenefitsandalternatives
tothestandardofcaretreatments.
Toachievegoals:
a. Readsandcompletesassignmentsindidacticeducationcourse.
i.e.Readandpresentchapters/articlesfromHomestudyandrhinology
textbook:Kennedy’s“DiseasesoftheSinuses”.
b. Developunderstandingofsinonasalanatomy/pathologyfromlectures,dissectioncourses(yearly
SouthernStatesRhinologycourse),aswellasfromOR/clinicexams.AttendResidentAllergycourse
onceduringresidency.Reference:KennedyDW,BolgerW,ZinreichS(eds):Diseasesofthe
Sinuses,DiagnosisandManagement.Hamilton,B.C.Decker,2001.
c.
Readthemedicalliteratureandshowanunderstandingoftherelevantrecentliteratureasit
appliestomanagementofallergic,inflammatorysinusdisease,andskullbaseneoplasms.
d.
UsePubMed,UptoDateandotherweb‐baseddatabasestolookupinformationoncurrentpatients.
e.
Keeptheelectronicmedicalrecorduptodate.
Practice‐BasedLearning&Improvement:
1. ParticipateinSinusdissectioncourseyearlyincorporatingprincipleslearnedfromdidacticsessions.
2. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.
3. Considerthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.
PatientCare(Goals):
1. Tounderstandtheproperevaluationofthepatientwithsinonasalorallergicdiseaseaswellas,
indicationsforendoscopicsinus/skullbasesurgery.
2. Tounderstandtheevidencebasedmedicalmanagementofthepatientwithsinonasaldisease.
3. Tomasterbasicendoscopicsurgicalplanningandoperativeset‐up.
4. Toefficientlyadministerandinterpretlaboratorytestsandtoproficientlyevaluateradiographicimages
oftheparanasalsinuses.
5. Toproficientlyuseinstrumentsusedforendoscopicsinussurgeryandroutineclinicuse.
6. Todescribeandperformthepropertechniquesandstepsinendoscopicsinussurgery:anterior
ethmoidectomy,middlemeatalantrostomy,completesphenoethmoidectomy,endoscopicandopen
septoplasty,clinic‐basedpost‐opcare,frontalrecessdissection,revisionsurgeryandforextended
applicationsincludingtumorremoval,CSFleakrepair,hypophysectomy,orbitaldecompression,and
opticnervedecompression.
7. Toperformthepropertechniquesforinvitro,skinprick,andintradermalallergytestingandmixingof
patientspecificserum.
8. Residentdemonstratesproficiencyispreppingandperformingofficebased,non‐sedatedprocedures
includingvocalfoldinjectionandtransnasalesophagoscopy.Theseniorresidentmustbeableto
appropriatelydescribethenuancesofintraoperativedecisionmakinginlaryngealframeworksurgery.
Toachievegoals:
a. ActivelyparticipateinoutpatientclinicsandOR’swithattendingsandallergynursingstaff.
b. Independentlyperformcomprehensiveallergyandrhinologichistory,physicalexamination
(includingnasalendoscopywithrigidandflexibletelescopes)andorderingofappropriate
diagnostictestingfortheclinicalproblem.
c. Makeapresumptivediagnosesandsynthesizeatreatmentplansforclinicandconsultpatients.
Then,presentpatientstotheattendinginanorganizedandmannerforcritique.
d.
e.
Learnandapplysurgicalindicationsfortreatmentofsinonasaldiseasebyincorporatinglabtest
andradiographicimagingintodecision‐makingprocess.
Followpatientsfromadmissiontodischarge:determiningappropriatetimefordischargeand
follow‐up.
Systems‐BasedPractice:
1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.
2. DiscussactivelythebuildingofnewhealthcareresourcessuchastheHillsboroughHospitalanditseffect
onpatientcareandphysicianlivelihood.
3. LearnandapplypropercodingandbillingprocessesforbothclinicandOR.