The four residents in the second year of otolaryngology training are at New York Eye and Ear Infirmary of Mount Sinai (NYEE) for nine months where they work under the close supervision of the attending staff and senior residents. Clinical experience at New York Eye and Ear Infirmary is one of the primary responsibilities and educational benefits of the second-year program. Residents rotate three months each on the Head and Neck, Otology/Neurotology, and Facial Plastic Services. For the remaining three months, residents are at Mount Sinai Beth Israel.
Upon arrival at New York Eye and Ear Infirmary, each resident is provided with a copy of the department's current reading list along with supplemental suggestions for each three-month block within the four-year program. The department's educational syllabus is given to incoming residents and reviewed with them periodically. Specific Goals and Objectives for each training site and year are available through the NYEE website. All incoming residents participate in a series of lectures and practical sessions that introduce them to clinical otolaryngology. The faculty and senior residents give this course. It summarizes the clinical problems that the new resident is most likely to encounter while performing regular hospital duties.
The educational emphasis during the second year exposes the new resident to the entire field of otolaryngology. The second-year resident's clinical responsibilities are to deliver ward and clinic care, and to perform selected surgical procedures under direct supervision. The resident assists in performing major surgical procedures and is guided in executing those portions of the operations that are appropriate to his or her level of training.
Second-year residents have a broad surgical experience due to the large number of operations performed annually. Over subsequent years, the surgical experienced has tended to remain constant, but the intensity of cases have increased reflecting the growing surgical case load at both the NYEE, and Mount Sinai Beth Israel. The operations most commonly performed by the second-year residents are tonsillectomy, adenoidectomy, myringotomy with insertion of tympanostomy tube, excision of skin lesions, closed reduction of nasal fracture, direct laryngoscopy, bronchoscopy, esophagoscopy, submandibular gland excision, and nasal septal reconstruction. In addition, second-year residents participate in most major otologic, head and neck, thyroid, and oncologic procedures. They are the first surgeon for tympanoplasties and assist on mastoidectomies. In order to assure that each resident receives a comparable experience, the Director of Residency Training and the Department Chair monitor the distribution of cases among the residents.
Second-year residents participate in ward rounds held on each service. The format varies from service to service. However, the general format is for daily evaluation of each patient on the service by the Chief Resident and attending in charge of the patient. The second-year resident presents each patient and the attending leads a Socratic-type discussion with extensive questioning of the residents about the evaluation and management of the patients. Suggestions for further reading are generally provided and residents are accountable by written examination.
During the three-month rotation on the head and neck service, weekly participation is required in the speech laboratory to conduct quantitative aerodynamic, kinematic, and acoustic evaluations of speech and voice, and to perform endoscopy and videostroboscopy. Selected patients are discussed at the monthly voice conference. A separate esophagoscopy clinic is held every Thursday morning to train junior residents in flexible esophagoscopy. Residents are also required to review their surgical pathologic specimens with the department's pathologist, Dr. Steven McCormick. The resident presents pre- and post- operative oncology cases at the combined Tumor Board. Selected topics, as they relate to the head and neck service, are presented during the Basic and Clinical Science Courses.
During the three-month rotation on the otology service, Dr. Linstrom and other attendings give weekly lectures on pertinent topics related to the clinical diagnosis and management of disorders of hearing, balance and the facial nerve. Selected topics, as they relate to otology, are presented during the Basic and Clinical Science Courses and in Temporal Bone Laboratory and Histopathology/Molecular Biology Course.
Exposure to audiology and speech pathology is provided through didactic lectures given throughout the year. Residents are required to attend an audiology practicum to gain hands-on knowledge of the mechanics of pure tone and speech audiometry, impedance audiometry, ENOG testing, brainstem response audiometry, electronystagmography, platform posturography, and rotation chair testing. The second year resident presents selected cases for discussion at the biweekly Audiology Conference. Combined Mount Sinai Beth Israel and NYEE Cochlear Implantation and Vestibular Conferences are held monthly. The residents and faculty present the clinical history, results of relevant testing (see above), and the pre- and post-operative status of cochlear implant patients. Additionally, the resident receives thorough training in the indications for amplification and common problems with hearing aids. A similar educational program is employed for speech pathology using the voice laboratory as the clinical environment and the voice conference as the teaching environment.
The second-year resident receives training in otolaryngologic allergy and immunology during the Basic Science Course and during the clinic sessions devoted to allergy. The residents gain a first hand knowledge of the treatment of allergic problems through their attendance at the weekly Allergy Clinic. The second-year resident receives instruction in both basic and clinical endocrinology during the Basic Science Course as well as during the rotation on the Head and Neck Service.
At the completion of each clinical rotation and for the subsequent entire period of training, each resident is required to evaluate anonymously each faculty member, their peers and the quality of each rotation using a web-based in-house developed system which conforms the Accreditation Council for Graduate Medical Education requirements for the six clinical competences (see ACGME.org). Residents anonymously annually review the entire program. Parameters evaluated include: teaching/mentoring, patient exposure, variety and complexity of surgical experience, environment, and overall satisfaction. Faculty members formally evaluate each resident semiannually to assess their clinical skills, patient and professional interactions, patient care, educational objectives, and research activities. These evaluations are discussed with the resident and any problems are resolved.