Three chief residents are assigned to New York Eye and Ear Infirmary with responsibility for the Head and Neck Service, the Otology Service, and the Facial Plastic and Reconstructive Service, respectively. The remaining three months are on the Head & Neck Service at Mount Sinai Beth Israel (see Goals and Objectives for specific cognitive and skill goals).
During the fifth year, residents assume greater supervisory responsibility for the clinic, ward, and operating room. The resident's primary surgical responsibility is to refine surgical technique and to perform major surgical procedures with varying levels of faculty assistance. Each chief resident directs the more junior residents on the respective services and reports to the faculty members in charge of the service. The chief residents meet frequently with the Department Chair and the Director of Residency Training to discuss their progress as well as to receive advice on administrative matters. Each year, the junior residents evaluate the performance of the chief residents with respect to their mentoring abilities and their stature as a role model. The most outstanding chief resident, based on these evaluations, is recognized annually.
The chief resident on the Head and Neck Service at both the NYEE and Mount Sinai Beth Israel perform all major head and neck procedures under the direct supervision of the attending staff. He or she may delegate certain of those cases to junior residents. He or she also provides direct supervision of the junior residents with the support of the attending staff. He or she receives training in all oncologic procedures, salivary gland and thyroid surgery, major flap reconstructive procedures, anterior skull base procedures, and management of maxillofacial trauma. The chief is trained in both standard and endoscopic treatment of paranasal sinus disease.
The chief Otology resident will within a three-month rotation, ordinarily perform several times the American Board of Otolaryngology operative experience for graduating residents in such areas as stapedectomy (approximately half with the argon laser), tympanoplasties, with/without mastoidectomy, and will assist in more advanced cases, such as cochlear implantations, surgery for Meniere's disease, facial nerve decompression and repair and surgery to correct congenital aural atresia. He or she supervises junior residents on the Otology Service in the performance of selected operative procedures. The chief resident participates in the pre-operative diagnosis and evaluation of retrocochlear and skull base cases. Skull base cases are scheduled at Beth Israel. Residents are joined in these cases by the resident in neurosurgery. These cases include acoustic neuroma, glomus tumors, meningiomas, and sinus neoplasms.
The chief resident on the Facial Plastic and Reconstructive Service performs all major facial plastic and reconstructive procedures. The chief resident will, during a three-month rotation, perform approximately 30 to 50 rhinoplasties, four face and brow lifts, 15 maxillofacial procedures, and 4 reconstructions for congenital facial anomalies. The chief resident assists on cleft lip and palate repair, major orthognathic cases, maxillofacial trauma, and repair of orbital fractures. Prior to 1997, the chief resident on the facial plastic service also served as the administrative chief resident. This resident met on a periodic basis with all other residents to identify such issues as working conditions, the schedule, and the overall educational program to be brought to the attention of the appropriate administrative staff. Since 1997, one chief resident is selected for the year to be administrative chief resident.
The chief residency year serves not only to give the residents broad and deep experience in operative cases, but also to develop their administrative abilities in a close working relationship with the Department Chair. It is expected that these experiences will prepare the graduating residents to assume positions in private and academic departments throughout the country. It should be noted that the chief residents are involved in various departmental and institutional committees relating to such issues as hospital management and the changing trends of health care delivery systems. As practiced in all years of training and all sites, chief resident are evaluate using the six clinical competences formulated by the ACGME.