Browse Otolaryngology Resident Training Program Goals and Objectives:
NYEE & Affiliated Hospitals | Beth Israel Medical Center | St. Vincent's Medical Center | Westchester County Medical Center | ACGME PGY 1 Otolaryngology Goals & Objectives

NYEE & Affiliated Hospitals

The following highly detailed description of the education program follows from the recommendation of the Accreditation Council on Graduate Medical Education focus on outcomes and measures of successful resident training. Over a several year period, the department has refined its goals and objectives for each hospital rotation at each level of training. Following the format of the ACGME, the department has formulated highly specific knowledge, skills and attitudes goals. In posting this information on the web, the department is communicating the faculties shared values and goals for resident education.

I. Educational Program at The New York Eye & Ear Infirmary

Resident education at the Eye and Ear encompasses clinical training in otolaryngologic medicine and surgery, didactic lectures, independent and supervised studies (i.e., microsurgical laboratory, head and neck surgical dissection course, Home Study Course, journal club), and basic and/or clinical research.

Clinical training is divided into three, three-month services at The New York Eye and Ear Infirmary. One 1st year, 2nd year, and 4th year Otolaryngology resident is assigned to the General/Head and Neck Surgery Service. One 1st year and 4th year resident rotates on the Otology/Neuro-otology Service, and the Facial Plastic & Reconstructive Surgery Service. Supervision of residents is based upon a hierarchical system. One 3rd year resident is assigned to the Academic Rotation. This rotation consists of laryngology, occuloplastic surgery, pediatric head and neck surgery, radiology, and surgical pathology.  The following table provides an overview of resident responsibilities:

Responsibility

Day / Time

Responsible Resident(s)

Responsible Faculty

Head & Neck Clinic

Monday, a.m.

All General/Head & Neck Surgery(G-H&N) residents

Drs. S. Schantz, K. Hu (radiation therapy)

Head & Neck Tumor Board

Monday, noon, once monthly

All General/Head & Neck Surgery(G-H&N) residents and all other residents attend

Drs. S. Schantz,  K. Hu, S. McCormick (pathology), R. Holliday or A. Khorsandi (radiology)

General Clinic

Monday, p.m.  
Tuesday, p.m.  
Wednesday, p.m.
Thursday, p.m.
Friday, p.m.  
Saturday, a.m.

All available residents

A. Sclafani,  M. Shawl, B. Wu, E. Chan, C. Douge, A. Ovchinsky

General Otolaryngology (Rhinology) OR

Monday, p.m. 

2nd & 4th year G-H&N residents

Dr. Branovan

Facial Plastic & Reconstructive Surgery OR

Monday, all day  
Thursday, all day 

1st & 4th year Facial Plastic & Reconstructive Surgery(FPRS) residents in am, 4th year FPRS in pm

Drs. A. Sclafani, M. Shawl, A. Ovchinsky, A. Jacono, S. Kushnick, M. Zimbler, Bass, Slupchynsky, Fallek, M. Abraham, E. Kwak

General Otolaryngology (Laryngology) OR

Thursday, p.m.

2nd & 4th year G-H&N residents

Dr. M. Pitman

Head & Neck OR

Tuesday, all day  
Thursday, all day 

1st or 2nd, 4th year G-H&N residents 

Dr. S. Schantz

Facial Plastic & Reconstructive Surgery Clinic

Tuesday, a.m.

1st & 4th year FPRS residents

Drs. A. Sclafani, M. Shawl, A. Ovchinsky, A. Jacono, S. Kushnick, M. Zimbler, Bass, Slupchynsky, Fallek, E. Kwak

Otology / Neuro-otology Clinic

Tuesday, a.m.
Thursday, a.m. 

1st & 4th year Otology resident, 2nd year G-H&N resident once weekly

Drs. C. Linstrom, A. Kim, G. Alexiades

Voice Clinic & Esophagoscopy

Thursday, 9:30 a.m. – 5:00 p.m.

3rd year Academic resident rotation.

Drs. M. Pitman, R. Baken

Voice Case Conference

3rd Thursday, 12:00 – 1:00

1st, 2nd, & 4th year residents

Drs. M. Pitman, R. Baken

Allergy

Wednesday, a.m.

1st year G-H&N resident

Dr. M. Teitel

Rhinology Clinic

Wednesday, a.m.  
Friday, a.m.

1st or 2nd year G-H&N resident, 2nd & 4th G-H&N on Friday 

D. Branovan, J. Li

Thyroid Clinic

Wednesday, p.m.

1st year G-H&N resident

Drs. S. Schantz, D. Branovan, S. McCormick, R. Holliday or A. Khorsandi, A. Gouler (endocrine)  

Otology OR

Wednesday, all day  
Friday, all day

1st & 4th year Otology resident

Drs. G. Alexiades, C. Linstrom, S. Parisier, A. Kim

General Head & Neck Surgery OR

Wednesday, all day

1st or 2nd year, 4th year G-H&N resident

Dr. S. Schaefer

Pediatric Head & Neck Surgery

Wednesday, all day

3rd year Academic resident rotation

Dr. M. Waner

Pediatric, General, Clinic

Monday-Friday, a.m.

1st year FPRS, G-H&N, Otology residents

Drs. T. He, E. Chan, B. Wu

Pediatric, Specialty Clinic

Friday, a.m.

1st & 2nd year G-H&N residents

Dr. R. Dyleski

Facial Plastic & Reconstructive Surgery (Occuloplastic Surgery) Clinic and OR

Monday, a.m.  
Friday, all day

3rd year Academic resident rotation.; 4th year FPRS resident

Drs. R. Della Rocca, J. Milite, E. Mahr, B. Moskowitz

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A. General/Head and Neck Service Educational Goals

Educational goals for this rotation include Head and Neck Surgery, Laryngology, Pediatric Otolaryngology and Rhinology.

1. First-Year Resident (PGY-2)

I. Knowledge Goals.  Upon completion of this rotation the PGY-2 resident will:

1. Describe the anatomy, embryology, and physiology of the upper aerodigestive tract as derived from the Basic Science Course, Journal Club, voice conference, Grand Rounds, Tumor Board, departmental courses, and specialty lectures (see Sections 8 and 9).
2. Explain the surgical anatomy of the head and neck, focusing on the clinical relevance of anatomical structures and their relationship to disease management.
3. Explain general considerations in otolaryngologic surgery, including:
1. Body composition of fluids and electrolytes in the resting state including insensible losses.
2. The intrinsic and extrinsic coagulation cascades.
3. Pulmonary function testing in the head and neck surgical patient. 
4. Common pulmonary function abnormalities in the head and neck patient and pulmonary support mechanisms.
5. Principles of endoscopy of the upper aerodigestive tract.
6. Principles and practice of diagnostic radiology. Be capable of understanding the principles and rationale including limitations of various radiographic assessments including CT scan, MRI, sonography, and radionuclide studies.
7. Principles of surgical pathology. Be capable of identifying common pathologic entities of the head and neck including but not limited to: intraepithelial neoplasia, squamous cell cancer; benign laryngeal lesions, congenital cystic lesions of the head and neck, pathologic entities of the exocrine and endocrine glands.
8. Historical evolution and principles of upper aerodigestive and pulmonary endoscopy.
9. Common agents used in anesthesiology including both local and general anesthetic agents. Knowledge of both contraindications and complications associated with these agents.
10. Preoperative risk assessment for specific organ systems in patients undergoing head and neck surgery.
4. Explain antimicrobial therapy and recent advances in therapy for otolaryngologic diseases.
5. Explain surgical treatment plans, results, and their complications for cancers of the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, nose, neck and skull base.
6. Explain the rationale and implications of AJCC staging in the treatment of these diseases.
7. Explain the epidemiology of neoplasms and role of carcinogenic agents in the development of pre-malignant and malignant disease.
8. Explain the application of multimodality therapy for cancers of the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, nose, neck and skull base, including:
1. Indications and rationale for radiation therapy and/or chemotherapy of cancers of the larynx and hypopharynx.
2. Principles of radiobiology, dosimetry and fractionation schemes in radiation oncology.
3. Management of the head and neck cancer patient undergoing radiation therapy.
4. Limitations and complications of radiation therapy.
9. Describe the natural history, histopathology, and treatment of non-squamous cell cancers of the pharynx, nose, salivary glands, skin and larynx.
10. Define the various types of free tissue transfer and their application to reconstruction of head and neck defects, including:
1. Describe the historical development of free tissue transfer.
2. Explain various donor site considerations.
3. Explain the post-operative management of the patient undergoing free tissue transfer.
11. Describe the natural history, histopathology, and treatment of thyroid, parathyroid and major and minor salivary glands neoplasms.
12. Explain the pathophysiology of laryngeal squamous cell carcinoma, including:
1. Local spread of tumor in the larynx, according to site of origin, with special emphasis on ligamentous and fascial barriers, as well as paths of extralaryngeal escape.
2. Lymphtic drainage of tumor, both intralaryngeal and extralaryngeal, with implications for treatment.
3. Diagnostic evaluation and plan of investigation.
4. Consequences to the voice of the disease and of its surgical and radiotherapy management. Compare voice outcomes for various treatment strategies for any given tumor.
5. The extent of the various partial laryngectomies, including supraglottic, vertical hemi- and supra- cricoid laryngectomies.
13. Describe strategies for voice and swallowing rehabilitation of patients' status post treatment for carcinoma.
14. Explain the etiology, histologic and gross appearance, consequences to laryngeal function, and management for granulomas and contact ulcers, cysts, Reinke's edema, and vocal fold paralysis.
15. Explain head and neck manifestations of systemic disease, including sarcoid, pemphigus, pemphigoid, AIDS, Wegener's granulomatosis, tuberculosis, rheumatoid arthritis, Sjogren syndrome, and relapsing polychondritis.
16. Explain the rationale for and basic techniques of voice therapy, including voice therapy evaluation and treatment plan formulation.
17. Describe the indications, success rates, complications and surgical options for sleep apnea surgical procedures, including the role of office-based procedures, pharyngoplasties, and maxillofacial procedures.
18. Explain the terminology of and differentiate types of otitis media, including:
1. Pathogenesis and pathophysiology.
2. Natural history of otitis media.
3. Signs and symptoms.
4. Diagnostic tools.
5. Treatment options.
19. Use the appropriate terminology to differentiate types of sinusitis (rhinosinusitis) in both adults and children, including:
1. Pathogenesis and pathophysiology.
2. Developmental anatomy.
3. Signs and symptoms.
4. Diagnostic tools, endoscopic and radiographic staging.
5. Treatment options.
20. Explain the pathophysiology of various types of adenoid and tonsil disease, including:
1. Signs, symptoms and related airway problems.
2. Diagnostic tools.
3. Treatment options.
21. Describe etiologies and evaluation of pediatric hearing disorders, including:
1. Serous otitis media.
2. Congenital hearing loss.
3. Acquired hearing loss.
22. Describe appropriate pediatric audiologic interventions (hearing aids, etc.) based on the patient's age and audiologic situation.
23. Describe the evaluation and management of pediatric patients with airway disorders, including:
1. Laryngeal papillomatosis.
2. Epiglottitis.
3. Subglottic stenosis.
4. Laryngomalacia.
24. Discuss congenital airway disorders in relation to the embryology and development of the larynx and trachea.
25. Discuss the physiology of the larynx with respect to its role in respiration, airway protection, and phonation, including:
1. The mechanism of the normal swallow.
2. The mechanism of quiet and effortful respiration.
3. The mechanism of phonation, including:
1. The body-cover theory of phonation, including the meaning and significance of the term "mucosal wave."
2. Physiologic features that account for differences in fry, modal and falsetto phonation.
3. Anatomic and physiologic correlates of voice quality.
4. Differences between male and female voices.
5. Voice change over the life of the human.
6. Mechanisms of pitch control.
7. Mechanism of loudness control.
8. Contribution of the supraglottal vocal tract to vocal quality, resonance, and loudness.
26. Discuss the etiology, diagnostic considerations, histopathology, and clinical characteristics of vascular and congenital anomalies of the head and neck.
27. Discuss the pathogenesis and treatment of neuroendocrine lesions of the head and neck, including glomus and carotid body tumors.
28. Discuss the pathogenesis and treatment of allergy.

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II. Skills Goals.  First-year residents are expected to apply the above knowledge to become proficient in the following skills by the end of this year of training:

1. Conduct a complete office-based physical exam of the head and neck.

2. Perform indirect mirror and flexible laryngoscopy and stroboscopy.

3. Develop a differential diagnosis for common presenting signs and symptoms of connective tissue and granulomatous diseases of the head and neck.

4. Maintain appropriate fluid and electrolyte balance in the perioperative care the head and neck surgical patient.

5. Demonstrate knowledge of the hematologic coagulation cascade to the perioperative care of the head and neck surgical patient.

6. Describe the classification of inflammatory diseases of cervical lymph nodes

7. Describe the histoarchitecture of cervical lymph nodes including architecture associated with inflammatory diseases.

8. Construct a differential diagnosis of patient presenting with inflammatory diseases of the cervical lymph nodes.

9. Conduct a differential diagnosis and evaluation of abnormal enlargement of the salivary glands.

10. Identify the clinical presenting signs and symptoms of oral cavity cancer including the physiologic and anatomic basis of this clinical condition.

11. Assess cranial nerve deficits related to oral cavity cancer.

12. Conduct a differential diagnosis of clinically-identified lesions of the head and neck including nasopharynx, nasal cavity and paranasal sinuses, oral cavity, pharynx, and larynx.

13. Identify the clinical presenting signs and symptoms of nasopharynx cancer including the physiologic and anatomic basis of these clinical conditions.

14. Assess cranial nerve function and skull base deficits related to nasopharynx cancer.

15. Identify the clinical presenting signs and symptoms of oropharyngeal, hypopharyngeal and laryngeal cancers, including the physiologic and anatomic basis of these clinical conditions.

16. Conduct a comprehensive assessment of esophageal physiology and esophageal disease.

17. Perform pre-operative and post-operative assessment and management of the patient undergoing pediatric, rhinologic, laryngologic and head and neck surgical procedures.

18. Evaluate risk factors in the preoperative assessment of surgical patients.

19. Perform long-term evaluation and management of the head and neck surgical patient.

20. Progress through outpatient clinic or emergency procedures under direct supervision of faculty as follows, but not limited to:

20

1000

21. Perform standard operative techniques:

    1. Incision placement for selected procedures.

    2. Surgical flap elevation.

    3. Wound closure and management.

    4. Surgical dissection and hemostasis.

    5. Appropriate surgical wound drainage.

22. Function as first assistant on major head and neck surgical procedures.

23. Perform ambulatory and inpatient surgical procedures. (The following operations are a modification of the RRC key procedures, and serve as minimal technical skill goals for General/Head and Neck Surgery Service at The Eye and Ear):

31622, 31635, 31630  

0-2 (0.75)

0-1 (0.5)

0-2 (0.5)

0 (0)

5

7

Sinus, sphenoid

20

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III. Attitude Goals.  Attitudes or "non-cognitive" goals refer to professionalism shown by a resident physician and are common to all years of training. Residents must:

1. Establish and maintain professional and therapeutic relationships with patients and healthcare team members.
2. Manage and maintain efficiency of the team. 
3. Meet regularly with surgical teaching staff for guidance and discussion of issues arising from the running of the team.
4. Demonstrate an understanding of the profound social stress that life-threatening conditions place on patients and their families and an appreciation of the manifestations of such stress.
5. Describe a variety of coping reactions that are commonly employed by patients with life-threatening illnesses.
6. Describe an appropriate therapeutic response for each of the common coping reactions that are employed by patients with life-threatening illnesses.
7. Demonstrate skill in dealing with the psychosocial dimension of head and neck oncology.
8. Describe the ethical issues that are involved in the treatment of patients with life-threatening illnesses.
9. Communicate effectively with patients and their families.
10. Demonstrate an understanding and appreciation of the importance of networking in the professional environment and how it can facilitate optimal patient care.
11. Discuss the rationale for networking in the professional environment.
12. Give examples of networking.
13. Demonstrate behaviors that reflect an ongoing commitment to continuous professional development, ethical practice, sensitivity to diversity, and responsible attitudes.
14. Use survey procedures to complete a 360-degree examination of leadership and produce an action plan with a faculty mentor to improve identified deficiencies.
15. Demonstrate habitual self-assessment to evaluate self-image and assumptions.
16. Show evidence of intermediate and long term planning for professional development.
17. Record all tasks that need to be accomplished and ensure that they are completed in a timely manner.
18. Develop a set of intermediate and long term goals at the start of the rotation and review with staff at mid-rotation and at the end of rotation.
19. Show evidence of implementation of a networking system.
20. Show a system (card, computer, etc.) to record information about professional contacts.
21. Maintain a personal operative record database.
22. Demonstrate insight into personal character and temperament and how they impact work.

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2. Second-Year Resident (PGY-3)

I. Knowledge Goals.  The second-year General/Head and Neck Surgery Service experience builds upon knowledge gained in the prior year in Head and Neck Surgery, Rhinology, Pediatric Otolaryngology and Laryngology. As in every year, such learning should be evident through interaction with faculty and other residents at teaching rounds and conferences, In-Service examination, Home Study Course and publications. In addition, the resident should be able to:

1. Describe the anatomy, embryology, and physiology of the aerodigestive track.
2. Describe the surgical anatomy of the head and neck
3. Identify critical anatomical spaces of the head and neck including parapharyngeal space and infratemporal fossa;
4. Describe the vascular anatomy of the head and neck.
5. Discuss the classification of various congenital disorders such as branchial cleft abnormalities.
6. Discuss general considerations in head and neck surgery.
7. Discuss blood volume and physiologic adaptations to blood loss.
8. Describe tests of intrinsic and extrinsic coagulation cascade and the assessment of platelet function.
9. Explain dosage schemes of various antibiotic regimens based on particular diseases
10. Define side effects of the different antibiotics used in otolaryngology.
11. Describe intra-operative complications involving respiratory, cardiac, renal, and hematologic systems including the definition and pathophysiology of shock.
12. Describe characteristics and management of postoperative complications involving specific organ sites.
13. Discuss advantages and limitations of current equipment used in endoscopy of the upper aerodigestive tract.
14. Define critical anatomic landmarks in laryngoscopy, esophagoscopy, and bronchoscopy including relative distances from central incisors.
15. Discuss principles of esophageal endoscopy, manometry, and ph monitoring.
16. Discuss the role of lasers, including laser biology, appropriate application, and treatment results in head and neck surgery.
17. Define genetic basis of cell cycle dysregulation in cancers of the head and neck.
18. Define critical cellular components in the metastatic process.
19. Describe laboratory-based immunologic parameters associated with head and neck cancer. 
20. Describe factors associated with immune depression and escape by head and neck cancer.
21. Explain the classification schemes for cervical lymph node metastases including AJCC classification schemes.
22. Define the AJCC staging parameters of cancers of the upper aerodigestive tract including cancers of the nasopharynx, paranasal sinuses, oral cavity, pharynx, and larynx.
23. Describe the assessment and diagnostic evaluation of patients with diseases of the oral cavity.
24. Explain the histopathologic classification systems of oral cavity cancer.
25. Discuss the diagnostic evaluation and staging of oral cancers
26. Describe the diagnostic characteristics, histopathologic characteristics, and natural history of benign lesions of the oral cavity including odontogenic tumors.
27. Describe the histopathologic classification systems of oropharynx cancer.
28. Discuss the current methodology for assessing speech and swallowing disorders.
29. Describe the techniques for post-operative rehabilitation of swallowing function in the patient treated for head and neck cancer.
30. Discuss the diagnostic considerations, histopathology, clinical course of acquired and congenital lesions of the larynx and hypopharynx.
31. Explain the principles of medical and surgical treatment of gastroesophageal reflux disease.
32. Explain sensitivity, specificity, and limitations relevant to the diagnostic tests for the thyroid nodule.
33. Describe histopathologic conditions related to the thyroid nodule.
34. Describe classification schemes for benign diseases of the major and minor salivary glands.
35. Describe the differential diagnosis of enlargement of the parotid gland.
36. Discuss the assessment and diagnostic evaluation of patients with diseases of the major and minor salivary glands.
37. Explain the epidemiology of malignant diseases of the major and minor salivary glands.
38. Describe the histopathologic characteristics of salivary gland neoplasias.
39. Describe the histopathologic characterization, diagnostic, and radiographic characteristics of connective tissue and granulomatous diseases of the head and neck.
40. Explain the diagnosis and management of deep space infections of the head and neck.
41. Define the causes of lymphadenitis, both viral and non-viral.
42. Describe the noninfectious causes of lymphadenopathy, including lymphadenopathy associated with systemic illness.
43. Describe the diagnostic evaluation of obstructive sleep apnea including physiologic sleep studies, sleep disorder scales, and radiographic assessments.
44. Discuss the role and characteristics of non-surgical management of sleep apnea.
45. Discuss the etiology, diagnostic considerations, histopathology, and clinical characteristics of vascular anomalies of the head and neck.
46. Discuss the pathogenesis and treatment of neuroendocrine lesions of the head and neck including glomus and carotid body tumors.

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II. Skills Goals.  The second-year Otolaryngology resident on the General/Head and Neck Surgery Service will build upon their first-year skills and demonstrate new skills as follows, but not limited to those outlined below:

1. Demonstrate:

   1. Expertise in the complete office-based physical exam of the head and neck, including assisting more junior residents and medical students in the teaching clinic.

   2. Advanced skills in the performance of indirect mirror and flexible laryngoscopy.

   3. Application of fine needle aspiration (FNA) and diagnostic assessment of inflammatory and neoplastic diseases of the cervical lymph node, neck masses and thyroid nodules.

   4. Development of medical and surgical management plans for diseases of the major and minor salivary glands.

   5. Management of branchial cleft and vascular abnormalities, including treatment of therapeutic complications.

   6. Endoscopic procedures of the upper aerodigestive tract including laryngoscopy, esophagoscopy, and bronchoscopy.

   7. Diagnostic assessment (e.g., staging endoscopy, CT and MRI imaging, and FNA) and capitulate staging parameters of squamous cell and non-squamous cell neoplasms of the head and neck in presentation of patients to Head and Neck Tumor Board, understanding of the relationship between clinical stage and prognosis.

2. Explain mechanisms of carcinogenesis of upper aerodigestive cancers as well as the critical elements of cellular dysregulation and metastases.

3. Discuss the measures of immune suppression in head and neck cancer and their biologic basis.

4. Explain the use of diagnostic procedures for diseases of the esophagus including the identification of abnormalities involving manometry, ph monitoring, and esophagoscopy.

5. Apply knowledge of multi-organ system risk factors towards the management of postoperative complications.

6. Create a treatment plan including long-term assessment and management for the patient with thyroid goiter.

7. Establish guidelines for the surgical and medical management of patients with hyperthyroidism.

8. Describe criteria for the surgical management of hyperthyroidism.

9. Describe criteria for the surgical management of Grave's ophthalmopathy.

10. Demonstrate ambulatory and inpatient surgical skills. The third-year General/Head and Neck Surgery Service resident should complete the following operative goals as part of their PGY-3 training at The Eye and Ear:

41155, 41155.52

0-2 (3.5)

0 (0.5)

3-5 (10.5)

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3. Fourth-Year Resident (PGY-5)

I. Knowledge Goals.  The fourth-year General/Head and Neck Surgery Service must demonstrate superior knowledge of Head and Neck Surgery, Rhinology, Pediatric Otolaryngology, and Laryngology. Such learning should be evident through mastery of the knowledge base of the prior years of training, interaction with faculty and other residents at teaching rounds and conferences, In-Service examination, Home Study Course and publications. The resident should:

1. Demonstrate mastery of all knowledge acquired in prior years.
2. Demonstrate application of acquired knowledge to the preoperative selection, operative and perioperative care, and avoidance and management of complications of patients on the General/Head and Neck Surgery Service. 
3. Discuss, in detail, the management of patients undergoing:
   1. Airway surgery: palatoplasty, tracheotomy.
   2. Endoscopy of the esophagus, larynx, sinuses, and trachea. 
   3. Open reduction and internal fixation with or without stenting of laryngeal fractures
   4. Laryngeal framework surgery, vocal fold medialization by injection and airway management by artyenoidectomy/arytenoidopexy.
   5. Laryngectomy:; total, horizontal, supraglottic and supracricoid.
   6. Maxillectomy:; medial and total with and without orbital exteneration.
   7. Neck dissection, modified and radical.
   8. Marginal and segmental mandibular resection.
      1. Resection of neoplasms of the upper aerodigestive tract.
      2. Parotidectomy, resection of parapharyngeal space and submandibular gland neoplasms.
      3. Thyroidectomy, parathyroidectomy.
      4. Vascular surgery; resection of carotid body tumors, repair of venous and arterial lacerations and ligation of major vessels of the head and neck.
   9. Treatment of acquired and congenital ear disease as described in the fourth-year rotation on the Otology/Neuro-otology Service.
   10. Airway surgery: bronchoscopy, esophagoscopy, management of acute epiglottitis, obstructive sleep apneas and removal of foreign bodies
   11. Excision of congenital cysts and sinuses (branchial cleft, thyroglossal duct).
   12. Resection of vascular tumors.
   13. Dacryocystorhinostomy.
   14. Drainage of orbital abscess; endoscopic and external approaches.
   15. Endoscopic antrostomy, ethmoidectomy, frontal sinusotomy and sphenoidotomy.
   16. External approaches to the paranasal sinuses; Caldwel Luc, ethmoidectomy, ligation of the internal maxillary artery, osteoplastic frontal sinusotomy and trephination.
   17. Orbital/optic nerve decompression.
   18. Repair of CSF rhinorrhea; endoscopic and external approaches.
   19. Septoplasty.
4. Discuss the obligations and skills necessary to direct the care of patients and the supervision of more junior residents in an acute care specialty hospital. 

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II. Skills Goals.

1. The resident must demonstrate ability to manage the General/Head and Neck Surgery Service, including:

   1. Direct supervision of junior residents and coordination of nursing, social services and administration to optimize patient care.

   2. Assist faculty with supervision of the general, head and neck, pediatric, rhinology and thyroid clinics.

   3. Develop the treatment plan for all patients undergoing medical or surgical care on the General/Head and Neck Surgery Service

   4. Direct the presentation of appropriate patients to the Head and Neck Tumor Board.