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, R. Hoffman

General Head & Neck Surgery OR

Wednesday, all day

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

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

 

TOP

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.

TOP

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:
Procedure Minimal Number Required Cumulative Program Average for PGY-2 Comment

Anterior nasal pack/ posterior nasal pack

10

20

Residents initially perform these procedures under direct faculty supervision. After demonstrating competence as judged by the faculty, the resident may be directly supervised by a chief resident, with the faculty present in the clinic

Cautery of nose

20

30

Fine needle biopsy

20

30

Flexible esophagoscopy

2

Flexible laryngoscopy

1000

1200

Incision & drainage peritonsillar abscess

5

15

Incision & drainage superficial soft tissue abscess (face, neck, septum)

5

10

Removal foreign body ear, nose

10

25

Microscopic exam ear

500

700

Myringotomy

5

10

Trach tube change 

5

10

Video-laryngoscopy

40

50

  1. 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.
  2. Function as first assistant on major head and neck surgical procedures.
  3. 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):
Procedure CPT-95 Expected Range & (Program Average) for PGY-2, assistant Expected Range & (Program Average) for PGY-2, surgeon Average, American Board of Otolaryn-gology Report of Graduating Residents, surgeon

Adenoidectomy

42830

0-1(1)

90-110 (116.5)

40

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision

42815, 60280, 30124/ 30125, 38555, 38550

2-4 (5)

2-4 (5.5)

9

Bronchoscopy, diagnostic

31622, 31635, 31630

0-1 (0.75)

0-2 (0.75)

59 (Increase experience by performing on all CA pts)

Cervical Mass Biopsy

38510

0-2 (3.5)

3-5 (4)

17.5

Composite resection

41155, 41155.52

0-2 (0.5)

0 (0)

7

Direct laryngoscopy, adult

31525, 31541

3-5 (5)

3-5 (6)

74

Direct laryngoscopy, pediatric

31520, 31530

0-1 (0.5)

0-2 (0.5)

8.5

Esophagoscopy

43200, 43215

0-2 (2)

0-2 (0.5)

54

Hemilaryngectomy, vertical

31370

0-1 (0)

0 (0)

1

Hemilaryngectomy, horizontal

31367

0-1 (0)

0 (0)

0.8

Laryngectomy, Total

31360

0-2 (1.75)

0 (0)

4

Laryngo-
pharyngectomy

31390

0-1 (0.5)

0 (0)

1.5

Laryngoplasty/ Arytenoidectomy/ Thyroplasty

31582, 31400, 31588

0-2 (0.25)

0 (0)

7

Maxillectomy

31225.52, 31225, 31230

1-4 (3)

0 (0)

5

Neck dissection

38720, 38724, 38724.52

2-6 (8)

0 (0)

42

Oral Cavity tumor, local resection/ glossectomy

41112, 41120, 41130, 41140

2-4 (4.5)

0-2 (2)

16

Parathyroidectomy

60500

0-3 (1)

0 (0)

4

Parotidectomy

42415, 42420, 42425

1-4 (3)

0 (0)

18

Pharyngo-
esophagectomy

43107

0-1 (0)

0 (0)

0.5

Reconstruction flaps, local

14040, 14020

0-4 (2)

0 (0)

13

Reconstruction flaps, muscle fasciocutaneous

15732

0-2 (1)

0 (0)

7

Sinus, antrostomy

31020

4-7 (4.25)

0 (0)

57.5

Sinus, ethmoid

31200

4-7 (4.25)

0 (0)

56

Sinus, frontal

31276

1-3 (2)

0 (0)

13

Sinus, sphenoid

31050

2-4 (2.75)

0 (0)

20

Sinus, frontal, osteoplastic

31084, 31086

0-2 (1)

0 (0)

2.8

Submandibular gland excision

42440

1-3 (1.5)

0-1 (0)

9

Surgical speech fistula (TEP)

31611

0-2 (1)

0 (0)

5

Tonsillectomy

42825.52, 42825.50

2-5 (3)

85-100 (95)

0

Thyroidectomy

60220, 60225, 60240

3-6 (8)

1-2 (5)

26.5

Tracheotomy

31600

2-4 (3.5)

2-4 (9.5)

70.5

TOP

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.

TOP

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.

TOP

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:
Procedure CPT-95 Expected Range & (Program Average) for PGY-3, assistant Expected Range & (Program Average) for PGY-3, surgeon Average, American Board of Otolaryn- gology Report of Graduating Residents, surgeon

Adenoidectomy

42830

0 (0)

2-8 (125.5)

40

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision

42815, 60280, 30124/ 30125, 38555, 38550

0 (1.5)

2-3 (8.5)

9

Bronchoscopy, diagnostic

31622, 31635, 31630

0-2 (2.25)

4-10 (19)

59

Cervical Mass Biopsy

38510

0 (3.5)

3-6 (18.25)

17.5

Composite resection

41155, 41155.52

0-2 (3.75)

0 (0.5)

7

Direct laryngoscopy, adult

31525, 31541

0 (3.5)

6-12 (49)

74

Direct laryngoscopy, pediatric

31520, 31530

0 (0)

0-1 (1.5)

8.5 (Increase experience with Dr. Dolitsky)

Esophagoscopy

43200, 43215

0-1 (1.75)

4-8 (19)

54 (Increase experience with flexible esoph in the clinic)

Hemilaryngectomy, vertical

31370

0-1 (1.25)

0 (0.25)

1

Hemilaryngectomy, horizontal

31367

0-1 (0.25)

0 (0.25)

0.8

Laryngectomy, Total

31360

0-2 (2.5)

0 (0.25)

4

Laryngo-
pharyngectomy

31390

0-1 (0.5)

0 (0)

1.5

Laryngoplasty/ Arytenoidectomy/ Thyroplasty

31582, 31400, 31588 

0-2 (3.5)

0-1 (2)

7

Maxillectomy

31225.52, 31225, 31230

0-3 (4)

0-1 (0.75)

5

Neck dissection

38720, 38724, 38724.52

3-7 (21)

0-2 (3)

42

Oral Cavity tumor, local resection/ glossectomy

41112, 41120, 41130, 41140

2-4 (5.25)

1-4 (7)

16

Parathyroidectomy

60500

2-4 (9.25)

0-2 (4)

4

Parotidectomy

42415, 42420, 42425

2-4 (10.5)

0-1 (2.75)

18

Pharyngo-
esophagectomy

43107

0-1 (0)

0 (0)

0.5

Reconstruction flaps, local

14040, 14020

0-2 (2.25)

0-2 (2.25)

13

Reconstruction flaps, muscle fasciocutaneous

15732

0-1 (2)

0 (0.5)

7

Septoplasty/ Turbinectomy 

30520, 30130

0 (9.75)

8-15 (42.5)

91

Sinus, antrostomy

31020

3-5 (9.75)

4-6 (11.75)

57.5

Sinus, ethmoid

31200

3-5 (10.5)

4-8 (10.25)

56

Sinus, frontal

31276

0-3 (4)

0-2 (1)

13

Sinus, sphenoid

31050

0-3 (4.75)

0-2 (3)

20

Sinus, frontal, osteoplastic

31084, 31086

0-2 (1.25)

0-1 (0.25)

2.8

Surgical speech fistula (TEP)

31611

0-1 (0.25)

1-2 (1.25)

5

Submandibular gland excision

42440

0-2 (4)

1-3 (4.5)

9

Tonsillectomy

42825.52, 42825.50

0 (1.25)

5-10 (107.5)

0

Thyroidectomy

60220, 60225, 60240

3-7 (28.25)

4-7 (17.75)

26.5

Tracheotomy

31600

0 (2.25)

4-8 (53)

70.5

TOP

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. 
TOP

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.

    5. The resident should utilize this fourth-year rotation at the Eye and Ear to both build upon and acquire new patient management skills as outlined above under Knowledge and those skills required for completion of prior years of training. 

  2. Provide appropriate ambulatory and inpatient surgical care consistent with programmatic and national standards for the following procedures at The Eye and Ear:
Procedure CPT-95 Expected Range & (Program Average) for PGY-5, assistant Expected Range & (Program Average) for PGY-5, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision  

42815, 60280, 30124/ 30125, 38555, 38550  

0 (8.4)  

0-2 (18.8)  

9

Bronchoscopy, diagnostic  

31622, 31635, 31630  

0 (5.8)  

4-8 (34.8)  

59 (Increase experience by performing on Ca cases)  

Cervical Mass Biopsy  

38510

0 (4.2)

0-4 (19.4)  

17.5  

Composite resection  

41155, 41155.52  

0 (3.8)  

0-2 (6.4)  

7  

Direct laryngoscopy, adult  

31525, 31541  

0 (9.2)  

5-12 (108.4)  

74  

Direct laryngoscopy, pediatric  

31520, 31530  

0 (0.8)  

0 (6.8)  

8.5  

Esophagoscopy

43200, 43215  

0 (1.2)  

4-8 (34.2)  

54 (Increase experience with flexible esoph in the clinic)  

Hemilaryngectomy, vertical  

31370

0 (0.8)  

0-1 (0.2)  

Hemilaryngectomy, horizontal  

31367

0 (1.4)  

0-1 (1.2)  

0.8  

Laryngectomy, Total  

31360

0 (6)  

0-2 (3.2)  

4  

Laryngo-
pharyngectomy

31390

0 (1.4)  

0-1 (0.4)  

1.5  

Laryngoplasty/ Arytenoidectomy/ Thyroplasty  

31582, 31400, 31588

0 (3)  

0-2 (3.6)  

7 (Increase experience by following voice pts & schedule with Dr. Sulica)  

Maxillectomy

31225.52, 31225, 31230  

0 (5.8)  

2-4 (6.8)  

5  

Neck dissection  

38720, 38724, 38724.52  

0 (21.8)  

4-10 (31.2)  

42 (Program recognizes the need to increase experience in this area)  

Oral Cavity tumor, local resection/ glossectomy  

41112, 41120, 41130, 41140  

0 (6.6)  

2-4 (15.8)  

16  

Parathyroidectomy  

60500

0 (5.4)  

2-5 (15.6)  

4  

Parotidectomy

42415, 42420, 42425  

0 (17)  

3-9 (20)  

18  

Pharyngo-
esophagectomy

43107

0 (1.25)  

0-1 (0.4)  

0.5  

Reconstruction flaps, local  

14040, 14020  

0 (8.6)  

0-4 (12.8)  

13  

Reconstruction flaps, muscle fasciocutaneous  

15732

0 (8.8)  

1-2 (7.2)  

7  

Sinus, antrostomy  

31020

0 (14.4)  

15-25 (40.6)  

57.5 (Program recognizes the need to increase experience in this area)  

Sinus, ethmoid  

31200

0 (14.2)  

15-25 (40.2)  

56

Sinus, frontal  

31276

0 (5.2)  

2-5 (8.8)

13 (Program recognizes the need to increase experience in this area)  

Sinus, sphenoid  

31050

0 (7.6)  

4-7 (14.4)  

20  

Sinus, frontal, osteoplastic  

31084, 31086  

0 (3.4)

1-3 (6.4)  

2.8  

Submandibular gland excision  

42440

0 (3.8)

1-4 (11.2)  

9

Thyroidectomy

60220, 60225, 60240  

0 (39.6)  

8-12 (74)  

26.5

Tracheotomy

31600

0 (5.6)  

0-5 (77.4)  

70.5

TOP

III. Attitude Goals.  At the completion of the fourth year of training, the resident should demonstrate both the attitudes noted for the previous years of training and have developed the professionalism necessary to direct the care of patients with complex head and neck, pediatric, rhinologic and laryngologic disorders. The latter at a minimum should include:

  1. Care effectively for patients with terminal disease, and assist their families with such problems by:

    1. Apply understanding of psychosocial aspects of dying to assist patients and their care-givers in the patient's appropriate placement for terminal care (i.e., home or hospice).

    2. Assist with identifying appropriate professionals to care for the non-otolaryngologic needs of the patient.

    3. Adopt the attitude that the physician is the health care advocate of the patient despite the current obstacles to maintaining the traditional patient-physician relationship.

TOP

B. Facial Plastic and Reconstructive Surgery Service Educational Goals

1. First-Year Resident (PGY-2)

I. Knowledge Goals.  Upon completion of this rotation the PGY-2 resident will have basic knowledge of the anatomy, embryology, and physiology of the hard and soft tissues of the face and neck as derived from the Basic Science Course, Journal Club, Facial Plastic Surgery Conference, Grand Rounds, departmental soft tissue course and specialty lectures (see Sections 8 and 9). The resident will:

  1. Demonstrate knowledge of biomedical, surgical, clinical, and social sciences relevant to patient care.

  2. Explain concepts of patient history and physical examination in Facial Plastic and Reconstructive Surgery, including:

    1. Components of a complete Facial Plastic and Reconstructive Surgery history and physicial, and how to perform such an examination.

    2. Formulation of an appropriate differential diagnosis.

    3. Formulation of an appropriate plan of investigation.

    4. Interpret plain radiographs, CT images and MRI images of the facial bones and related structures.

    5. Classification of facial nerve injuries.

    6. Classification of auricular malformations.

    7. Perioperative management of patients presenting to the Facial Plastic and Reconstructive Surgery clinic.

    8. Present new and established patients with disorders related to Facial Plastic and Reconstructive Surgery in a clear, concise and accurate way.

  3. Describe the anatomy and physiology relevant to facial plastic and reconstructive surgery, including:

    1. Anatomic landmarks and terminology used in nasofacial analysis.
    2. Facial proportional relationships and common methods of defining key angles, aesthetic units, Frankfort horizontal line, etc.
    3. Define the SMAS and understand its relationship to the facial nerve and facial muscles.
    4. Describe the anatomy, physiology and pathophysiology of the skin.
    5. Describe the Anatomy and physiology of local skin flaps.
    6. Describe the Anatomy of the eyelid and periorbita.
    7. Explain the embryology of the external ear.
    8. Explain the anatomy of the eyelid, as well as the mechanisms of injury of these structures.
    9. Describe the anatomy and embryology of the external ear and classify major auricular anomalies.

  4. Discuss the clinical presentation and pathophysiology of facial defects and deformities, including:
    1. Mechanisms of injury for common facial injuries.
    2. Potential for associated injuries in specific scenarios of facial trauma.
    3. Mechanisms of facial fractures, with emphasis on specific constellations and types of maxillary and mandibular fractures.
    4. Pathophysiology of nasal obstruction.
    5. Genetics and physiology of hair loss.
    6. Norwood's classification of hair loss.
  5. Discuss concepts relevant to surgical repair of facial defects and deformities, including:
    1. The temporal sequence of events in wound healing.
    2. Biochemical and cellular events of normal and disordered wound healing.
    3. Mechanisms of bone healing.
    4. Formulation of an appropriate plan of medical or surgical treatment for the patient with congenital or disease processes involving the face or seeking aesthetic changes.
    5. Correction of the secondary nasal deformities in terms of the nasal tip tripod concept.
    6. Angiosome concept pertaining to flaps.
    7. Soft tissue anatomy of the face with respect to surgical rejuvenative procedures.
    8. Basic approaches to face and brow lifting.
    9. Aesthetics associated with brow and face-lift.
    10. Basis for correction of prominent ears.
    11. Appropriate diagnostic tests for evaluation of facial paralysis.
  6. 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).

II. Skill 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. Perform appropriate triage and initial general management, as well as implement acute management for soft tissue trauma in order to reduce the risk of complications.

  2. Perform appropriate triage and initial general management, as well as implement acute management for ear or eyelid trauma in order to reduce the risk of complications.  Know the need for ophthalmologic or other testing or consultation.

  3. Anticipate how trauma might affect the functions, origins, insertions and actions of facial mimetic muscles, nerves and vessels.

  4. Appreciate the need for and implement the initial general trauma management in patients sustaining injuries to the head and neck.

  5. Investigate, evaluate, and improve patient care practices, including:

    1. Analyze basic facial features and recognize abnormal relationships.

    2. Manage acute and chronic wound healing to maximize surgical results.

    3. Describe and draw basic bony facial anatomy.

    4. Describe and draw facial and nasal subunits.

    5. Interpret major features of axial and coronal CT and T1/T2 MRI scans in patients with facial anomalies.

    6. Plan several possible skin flaps for closure of facial defects, and integrate patient specific features as variables in selecting a given flap.

    7. List possible pedicled and free flaps appropriate for a particular setting and the proper pre-operative preparation for a specific free flap repair. 

    8. Demonstrate the technique of free flap repair and anticipate potential complications.

    9. Completely evaluate and diagnose patients with suspected fractures of the mandible and maxilla and institute appropriate initial management.

    10. Describe the mechanisms of facial fractures, with emphasis on specific constellations and types of orbital and frontal sinus fractures.

    11. Evaluate and diagnose patients with suspected nasal and naso-ethmoid, and institute appropriate initial management.  

      1. Anticipate the need for ophthalmologic and neurosurgical consultation.

    12. Assess patients for the cause(s) of nasal obstruction.

      1. Formulate a plan for treatment of nasal obstruction.

      2. Assess dorsal nasal deformities.

    13. Assess and categorize primary and secondary nasal deformities.

      1. Describe the steps of closed and external rhinoplasty.
      2. Describe cleft lip nasal findings.
    14. Institute appropriate emergency management of facial nerve trauma.

  6. Progress through outpatient clinic or emergency procedures under direct supervision of faculty as follows, but not limited to:
Procedure Minimal Number Required Cumulative Program Average for PGY-2 Comment

Closure of facial and nasal skin laceration

0

3

Residents initially perform these procedures under direct faculty supervision.   After demonstrating competence as judged by the faculty, the resident may be directly supervised by a chief resident, with the faculty present in the clinic

Closure of ear laceration  

0

3

Excision of benign skin neoplasms  

3

10

Biopsy malignant skin neoplasms  

0

5

Closed reduction nasal fractures  

2

5

Drainage of auricular hematomas  

3

6

Incision & drainage superficial soft tissue abscess(face, neck, septum)  

5

10

Intralesional injections  

10

20

Local flap/adjacent tissue transfer, closure of defect (e.g., torn ear lobule)  

3

10

  1.   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 the Facial Plastic and Reconstructive Surgery Service at The Eye and Ear:

Procedure CPT-95 Expected Range & (Program Average) for PGY-2, assistant Expected Range & (Program Average) for PGY-2, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Blepharoplasty

15822/8, 15823, 15820/1

2-5 (3.5)

0 (0)

0

Brow Lift

15824/.5, 67900/.5

0-3 (1)

0 (0)

0

Cleft repair, Lip

40700/1/2

0-1 (0)

0 (0)

0.8

Cleft repair, Palate

42200/ 05/10, 42215/25

0-1 (0)

0 (0)

1

Excision skin lesions, primary closure

11440/6, 11420/6, 11620/6, 11640/6

1-3 (1.5)

5-15 (6)

28.5 (Increase experience in clinic and minor OR)

Facial Rehabilitation, static sling/ muscle transfer

15840/1, 15842/5

0-1 (0.5)

0 (0)

1

Facial Rehabilitation, nerve transfer

64885/6, 64868

0-1 (0.5)

0 (0)

0

Grafts, Split-thickness skin

15120

0-2 (2)

0-1 (1)

14

Grafts, Full-thickness skin

15240

0-1 (1)

0 (0)

4.5

Grafts, Composite/ dermal/ fat/ fascia/ cartilage/ bone/ other

15760, 15770, 21230, 20910, 15350

0-1 (0.5)

0-1 (0.5)

10

Microtia Repair

21230, 14060, 15120, 15760

0-2 (0.5)

0 (0)

0

Other eyelid procedures (e.g, ectropion, ptosis repair)

n/a

0-3 (2)

0 (0)

0

Otoplasty

69300, 69300.50

0-2 (0.5)

0 (0)

3

Pharyngeal Flap

42226

0-1 (0)

0 (0)

1

Repair complex laceration

13131

0-1 (0)

0-1 (1.25)

0

Reduction facial fracture, nasal

21310/ 21036

0-3 (1.5)

2-6 (3)

10.5

Reduction facial fracture, malar

21356/ 21366

0-1 (0.5)

0 (0)

7

Reduction facial fracture, mandible

21453, 21454/ 21470

0-1 (0.5)

0 (0)

17.5

Resurfacing Procedures

15780

0-1 (0.5)

0-1 (0.5)

1.3

Rhinoplasty

30400, 21210

8-15 (11)

0 (0)

16

Rhytidectomy

15826/8/9

0-2 (0.5)

0 (0)

2.75

Scar Revision

12001/18, 13131/52

1-4 (2)

2-4 (4)

22

Septoplasty/ Turbinectomy

30520, 30130

5-10 (19)

5-10 (6.25)

91 (increase experience during tonsil OR day)

TOP

III. Attitude Goals.See A.1.III.

2. Fourth-Year Resident (PGY-5)

I. Knowledge Goals.The fourth-year resident on the Facial Plastic and Reconstructive Surgery should build upon knowledge base acquired in the prior years and should:

  1. Describe concepts of patient history and physical examination in Facial Plastic and Reconstructive Surgery, including:

    1. Demonstrate mastery of all knowledge goals developed in the third year.

    2. Apply methods of analysis to unique individuals to assist with development of a surgical plan for aesthetic improvements.

  2. Describe the clinical presentation and pathophysiology of facial defects and deformities, including:

    1. Pathology associated with cleft lip nasal deformity.
    2. Mechanisms, diagnosis and management of blepharoplasty complications.
  3. Explain concepts relevant to surgical repair of facial defects and deformities, including:
    1. Management of post-traumatic CSF rhinorrhea.  
    2. Rationale for and techniques of cartilage grafting to the nose.
  4. Describe methods of skin rejuvenation.

  5. Describe management issues associated with patients with microtia.  
  6. Discuss characteristics of facial aging, including:  
    1. Characteristics of forehead and periorbital aging.  
    2. Characteristics of the aging nose.  
    3. Characteristics and clinical presentations of the senescent midface.  
    4. Characteristics of the aging mouth, jawline and neck.  
    5. The Dedo classification of the aging neck.  
  7. Discuss complex primary or secondary deformities of the nose, including:  
    1. Nasal valve stenosis.  
    2. Nasal valve collapse.  
    3. Twisted nose.  
    4. Middle vault collapse.
    5. Pollybeak deformity.  
    6. Columellar-alar disparity.  
    7. Nasal tip bossa.  
    8. Tip ptosis.  
    9. Tip retraction.  
    10. Tip under- or over- projection.  

II. Skill goals.  Fourth year residents should continue to build upon the skills acquired during the first three years of residency and demonstrate the ability to:

  1. Select patients, plan and execute scar revision techniques.
  2. Perform pedicled myocutaneous flaps for head and neck reconstruction.
  3. Execute the techniques of repair of comminuted or complex nasoethmoid, orbital and frontal bone fractures, as well as repair of injuries of the orbital adnexa.  
  4. Manage CSF leaks, surgically and non-surgically.  
  5. Implement techniques for correction of secondary and cleft lip nasal deformities based on a thorough understanding of the nasal tip tripod concept, using closed or open approaches, including management of:  
    1. External nasal valve collapse.
    2. Nasal valve stenosis.
    3. Twisted nose.
    4. Pollybeak deformities.
    5. Bossae, over- or under- projecting tips.
    6. Tip ptosis.
    7. Alar retraction.
    8. Columellar show.
    9. Under- and over- rotation of the nasal tip.
  6. Perform appropriate skin rejuvenation (lasers, superficial or medium depth chemical peels) based on patient- specific findings.  
  7. Apply brow and face lifting techniques to specific patients.   
  8. Diagnosis and manage brow and facelift complications.  
  9. Perform lower blepharoplasty (transcutaneous or transconjunctival).  
  10. Perform cheek and chin implantation.  
  11. Perform interposition nerve grafts, facial nerve reanimation, nerve muscle transfer, dynamic slings, and ancillary procedures for facial paralysis.  
  12. Perform further ambulatory and inpatient Facial Plastic and Reconstructive Surgery procedures at The Eye and Ear:
Procedure CPT-95 Expected Range & (Program Average) for PGY-5, assistant Expected Range & (Program Average) for PGY-5, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Blepharoplasty

15822/8, 15823, 15820/1

0-3 (4.2)

2-6 (3.6)

0

Brow Lift

15824/.5, 67900/.5

1-2 (2.8)

1-3 (1.8)

0

Cleft repair, Lip

40700/1/2

0-1 (0.8)

0-1 (0.2)

0.8 (increase experience by scrubbing with Smith / Schwimmer at BIMC on non-OR days)

Cleft repair, Palate

42200/05 /10, 42215/25

0-1 (1.4)

0-1 (0.8)

1

Excision skin lesions, primary closure

11440/6, 11420/6, 11620/6, 11640/6

0 (2.2)

2-4 (16.2)

28.5

Facial Rehabilitation, static sling/ muscle transfer  

15840/1, 15842/5

0 (2)  

0-1 (1.2)  

1

Facial Rehabilitation, nerve transfer  

64885/6, 64868

0-1 (0.4)  

0-1 (0)  

0

Grafts, Split-thickness skin

15120

0 (1)  

0-2 (13)  

14  

Grafts, Full-thickness skin  

15240

0 (0.4)  

0-1 (2.8)  

4.5  

Grafts, Composite/ dermal/ fat/ fascia/ cartilage/ bone/ other  

15760, 15770, 21230, 20910, 15350  

0 (1.6)  

0-2 (4.4)  

10 (Increase experience by logging cartilage grafts from otology cases)  

Microtia Repair  

21230, 14060, 15120, 15760  

0 (2.8)  

0-2 (0.6)  

Other eyelid procedures (e.g., ectropion, ptosis repair)  

n/a

0 (5.4)  

1-4 (2.2)  

0  

Otoplasty

69300, 69300.50  

0 (3.2)  

2-6 (4.8)  

3  

Pharyngeal Flap  

42226

0 (0.4)  

0-1 (0.2)  

1  

Repair complex laceration  

13131

0 (1)  

0-1 (13)  

0  

Reduction facial fracture, nasal  

21310/ 21036

0 (4.6)  

3-7 (12.6)  

10.5  

Reduction facial fracture, malar  

21356/ 21366  

0 (5)  

0-2 (5)  

7  

Reduction facial fracture, mandible  

21453, 21454/ 21470

0 (5)  

0-1 (5)  

17.5 (Increase experience by scrubbing with Schwimmer at BIMC on non-OR days)  

Resurfacing Procedures  

15780

0 (0.8)  

0-3 (0.6)  

1.3  

Rhinoplasty

30400, 21210  

0 (25.2)  

15-40 (18.2)  

16  

Rhytidectomy

15826/8/9  

0 (4.2)  

0-2 (1.2)  

2.75  

Scar Revision  

12001/18, 13131/52

0 (2.6)  

1-4 (9.2)  

22  

TOP

III. Attitude Goals.  See A.1.III. and A.3.III.

C. Otology/Neuro-otology Service Educational Goals

1. First-Year Resident (PGY-2)

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

  1. Explain the anatomy, embryology, and physiology of the temporal bone and related structures as derived from the Basic Science Course, Journal Club, Grand Rounds, Microsurgical Laboratory (temporal bone lab), departmental courses and specialty lectures (see Sections 8 and 9)

  2. Describe the surgical anatomy of the temporal bone and related structures, with a focus on the clinical relevance of anatomical structures, their physiology and their relationship to disease management.

  3. Describe:
    1. Biomechanics of the external and middle ear in hearing.
    2. Biomechanics of the inner ear, neural processing by the cochlear nerve and brain.
    3. Biomechanics of the vestibular system, neural processing of the vestibular nerve and brain.
    4. Etiology and consequences of genetic hearing loss.
  4. Describe the etiology, histopathology and treatment of acute and chronic infectious, inflammatory and neoplastic diseases of the temporal bone, such as syphilis, lyme disease, otosclerosis, and leukemia.
  5. Discuss the following:
    1. Physics of sound.
    2. Pure tone audiometry, bone conduction and masking, Bekesy audiometry, tone decay testing.
    3. Speech reception threshold.
    4. Impedance audiometry.
    5. Electrocochleography, auditory brainstem response.
    6. Threshold auditory, neonatal screening.
    7. Hearing aid selection, external and implantable.
  6. Describe the natural history, clinical presentation, and evaluation of otitis media, including:
    1. Antibiotic and surgical treatment options.
    2. Role of tympanostomy tubes and adenoidectomy.
    3. Epidemiology of otitis media and consequences of delayed or inadequate treatment.
  7. Discuss the diagnosis and management of acute and chronic vertigo, including:
    1. Differential diagnosis of vertigo.
    2. Vestibular testing, including ENG, postural platform, and torsion swing.
    3. Selection of appropriate imaging studies.
    4. Medical and surgical management of acute and chronic vertigo.
  8. Discuss the diagnosis and management of  acute and chronic facial nerve paralysis, including:
    1. Analysis of facial movement.
    2. Facial nerve testing, including current and historical methods.
    3. Medical and surgical management of acute and chronic facial nerve paralysis.
  9. Discuss the etiology and management of sudden hearing loss.
  10. Discuss the applied biomechanics, anatomic basis and operative techniques for surgical restoration of hearing, including:
    1. Tympanostomy tubes.
    2. Type 1 through 5 tympanoplasty.
    3. Canal wall up versus canal wall down mastoidectomy.
    4. Ossiculoplasty
    5. Stapedectomy
    6. Congenital middle ear reconstruction.
    7. Cochlear implant.
    8. Mechanisms of failure and complication of surgical treatment of hearing loss.
    9. Treatment of post-surgical complications, such as further hearing loss and vertigo.

II. Skill 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 complete office-based physical exam of the ear and related structures, including:

    1. Microscopic examination of the ear.

    2. Use of tuning forks.

    3. Obtain and interpret an audiogram.

    4. Quantify facial nerve function.

    5. Perform and Interpret facial nerve tests.

    6. Interpretation of vestibular tests, including ENG, rotational chair, and platform posturography.

  2. Appropriately apply and interpret CT and MRI to evaluate hearing loss, chronic otitis media, facial nerve paresis/paralysis, vertigo, and benign and malignant neoplasms of the temporal bone.
  3. Evaluate and medically manage hearing loss, including:
    1. Idiopathic sudden hearing loss, perilymph fistula.
    2. Syphilis, otitis media, cholesteatoma, Meniere's disease, herpes zoster.
  4. Conduct a pre-operative evaluation and decision process for:
    1. Simple mastoidectomy, and canal wall up versus canal wall down mastoidectomy.
    2. Middle ear reconstruction.
    3. Stapedectomy.
    4. Injection of gentamycin into the inner ear for vertigo.
    5. Labyrinthectomy, endolymphatic shunt and vestibular nerve sectioning.
  5. Progress through outpatient clinic or emergency procedures under direct supervision of faculty as follows, but not limited to:
Procedure Minimal Number Required Cumulative Program Average for PGY-2 Comment

Removal foreign body ear

10

20

Residents initially perform these procedures under direct faculty supervision. After demonstrating competence as judged by the faculty, the resident may be directly supervised by a chief resident, with the faculty present in the clinic.

Myringotomy

5

10

Injection of middle ear cleft (e.g., Gentamicin injection)

0

1

Tympanocentesis

0

1

Debridement, mastoid cavity

10

20

Particle repositioning (e.g., Epley maneuver)

10

15

Removal, cerumen

50

150

  1. 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 the Otology/Neuro-otology Service at The Eye and Ear:

Procedure CPT-95 Expected Range & (Program Average) for PGY-2, assistant Expected Range & (Program Average) for PGY-2, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Acoustic Neuroma/ CP Angle tumor resection  

61526

0(0) 

0(0)

0.6

Bone anchored hearing aid

n/a  

0-3 (n/a)  

0 (0)  

n/a  

Canalplasty/ Fistula repair/ other otology

n/a

0-2 (0.5)  

0 (0)  

0

Cochlear implant/ middle & posterior fossa surgery  

61590/ 61598, 61605, 61616, 69930  

0-3 (1.5)  

0 (0)  

3.8  

Congenital auricular atresia, repair  

69320

0-2 (0)  

0 (0)  

0.5  

Endolymphatic sac decompression +/- shunt  

69805, 69806  

0 (0)  

0 (0)  

1.4  

Facial Nerve Decompression

69720/5  

0-1 (0)  

0 (0)  

0.5  

Facial nerve graft/repair/ substitution

69740, 69745  

0-1 (0.5)

0 (0)  

1

Glomus tumor removal  

69550

0-1 (0.5)  

0 (0)  

0.6  

Labyrinthectomy

69905, 69910  

0 (0)

0 (0)

1.5

Modified/Radical Mastoidectomy  

69505, 69511  

1-5 (1)  

0 (0)  

6  

Myringotomy and tympanostomy tubes  

69436

1-5 (1.5)  

50-75 (58)

157

Petrous Apicectomy

69530

0 (0)  

0 (0)  

0.15  

Stapedectomy

69660

1-5 (2.5)  

0 (0)  

5.8  

Simple Mastoidectomy

69502

1-5 (0.5)  

0 (0)  

8  

Tympanoplasty Type I  

69620/ 69631  

2-6 (3.25)  

1-3 (0.5)  

22 (will log more during otology rotation)  

Tympanoplasty Type II-IV  

69632/3  

1-4 (1)  

0 (0)  

10  

Tympanoplasty with Mastoidectomy

69635/7, 69641/2  

3-7 (3.5)  

0 (0)  

15.5  

Vestibular nerve section  

69915

0 (0)  

0 (0)  

0.1  

TOP

III. Attitude Goals.  See A.1.III.

2. Fourth-Year Otology/Neuro-otology Resident (PGY-5)

I. Knowledge Goals. The fourth-year resident on the Otology/Neuro-otology service should build upon knowledge base acquired in the prior years to:

  1. Describe concepts of patient history and physical examination in Otology/Neuro-otology, including:

    1. Demonstrate mastery of all knowledge developed in the preceding years.

    2. Apply methods of analysis to unique individuals to assist with development of a surgical plan for aesthetic improvements.

  2. Discuss the interpretation of plain radiographs, CT images, MRI/ MRA and 4-vessel arteriographic and venographic images of the temporal bone, base of skull and related structures.
  3. Discuss the diagnosis and medical and/or surgical management of patients with:
    1. Chronic otitis media and cholesteatoma.
    2. Congenital middle ear anomalies.
    3. Congenital and acquired deafness.
    4. Temporal bone fractures.
    5. CSF otorrhea.
    6. Perilymph fistula.
    7. Glomus tympanicum and jugulare.
    8. Acute and chronic dizziness and vertigo.
    9. Auricular atresia.
    10. Primary or metastatic neoplasms of the temporal bone.
    11. Facial paralysis.
  4. Discuss adverse consequences of not treating, potential complications from surgical management of, and long-term management strategies for:
    1. Chronic otitis media and cholesteatoma.
    2. Congenital middle ear anomalies.
    3. Congenital and acquired deafness.
    4. Temporal bone fractures.
    5. CSF otorrhea, purulent otorrhea.
    6. Perilymph fistula.
    7. Glomus tympanicum and jugulare.
    8. Acute and chronic dizziness and vertigo.
    9. Auricular atresia.
    10. Primary and metastatic neoplasms of the temporal bone.
    11. Facial paralysis.
    12. Otosclerosis.

II. Skill Goals.

  1. Demonstrate mastery of all skills acquired in the previous three years.
  2. 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 the fourth-year Otology/Neuro-otology Service resident at The Eye and Ear:
Procedure CPT-95 Expected Range & (Program Average) for PGY-5, assistant Expected Range & (Program Average) for PGY-5, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Acoustic Neuroma/ CP Angle tumor resection

61526

0 (4)

0 (0)  

0.6  

Bone anchored hearing aid  

n/a  

0-2 (n/a)  

0-3 (n/a)  

n/a  

Canalplasty/ Fistula repair/ other otology  

n/a  

1-3 (5.4)  

4-8 (11.6)  

0  

Cochlear implant/ middle & posterior fossa surgery  

61590/ 61598, 61605, 61616, 69930  

2-4 (10.4)

1-5 (1.8)  

3.8  

Congenital auricular atresia, repair  

69320

0-2 (0.8)  

0-2 (0.8)  

0.5  

Endolymphatic sac decompression +/- shunt  

69805, 69806  

0 (0.2)  

0 (0.2)  

1.4  

Facial Nerve Decompression  

69720/5  

0-1 (0.4)  

0-1 (0.2)  

0.5  

Facial nerve graft/repair/ substitution  

69740, 69745  

0-1 (0.4)  

0-1 (0.2)  

1  

Glomus tumor removal  

69550

0-2 (1)  

0-1 (0.6)  

0.6  

Labyrinthectomy

69905, 69910  

0 (1)  

0 (0.8)  

1.5  

Modified/Radical Mastoidectomy  

69505, 69511  

0 (5)  

6-12 (6.6)  

6  

Myringotomy and tympanostomy tubes  

69436

0 (4.2)  

5-10 (133.4)  

157  

Petrous Apicectomy  

69530

0-2 (1.2)  

0 (0)  

0.15  

Stapedectomy

69660

0-2 (4.2)  

5-20 (9)  

5.8  

Simple Mastoidectomy

69502

0 (2)  

4-10 (5.6)  

8  

Tympanoplasty Type I  

69620/ 69631  

0 (10)  

6-12 (20.4)  

22

Tympanoplasty Type II-IV

69632/3

0 (4.4)

6-12 (7)

10

Tympanoplasty with Mastoidectomy  

69635/7, 69641/2  

0 (7.8)  

15-30 (18.8)  

15.5  

Vestibular nerve section  

69915

0 (0.4)  

0 (0)  

0.1  

TOP

III. Attitude Goals.  See A.1.III and A.3.III.

D. Academic (Audiology, Laryngology, Oculoplastic Surgery, Radiology, Rhinology, Pediatric Head and Neck Surgery and Surgical Pathology) Service Educational Goals

1. Third-Year Resident (PGY-4)

This rotation was begun in July 2002 to address concerns noted in the Departmental internal review process regarding: 1) refining Rhinology training and formalizing sinus surgical training in the PGY-4 year, 2) intensifying training in the diagnosis and management of voice and swallowing disorders, 3) increasing training in orbital trauma and oculoplastic surgery through utilizing the well established trauma and orbital surgery service at the Eye and Ear under the direction of Dr. Robert Della Rocca, and 4) furthering practical training in audiology.  In addition, the availability of excellent radiologists (Dr. Roy Holliday) permitted one-on-one resident mentoring and the rotation was enhanced by one half day per week in this area. In August 2004, Dr. Milton Waner relocated to the main campus of Beth Israel permitting residents to enhance their pediatric head and neck/facial plastic surgery experience through attending his service. This rotation is organized as follows:

Day Rotation Faculty

Monday

Operating Room - Oculoplastic Surgery
Pediatric Otolaryngology Clinic 

Bruce Moskowitz, MD
Robin Dyleski, MD

Tuesday

General Otolaryngology & Head & Neck Surgery

Ed Shin, MD  

Wednesday

Pediatric Head and Neck Surgery


Vascular Malformations  

Milton Waner, MD
Robin Dyleski, MD

Thursday

Laryngology & Esophagoscopy

Michael Pitman, MD
Ron Baken, PhD

Friday

Head and Neck Radiology
Operating Room-Oculoplastic Surgery  

Roy Holliday, MD
Robert Della Rocca, MD

 

TOP

I. Knowledge Goals.  Upon completion of this rotation and the academic year, the PGY-4 resident should understand and be prepared for their final training year in the following:

  1. Practical evaluation of hearing disorders, including (requirements as modified from Campbell KCM. Audiology Curriculum Guidelines for Otolaryngologists. Am J Audiology. 1995; 4:35-34)
    1. Pure tone audiometry.
    2. Speech audiometry.
    3. Acoustic immittance testing.
    4. Otoacoustic emission testing.
    5. ABR, ASSR, ECogH.
    6. Pediatric audiometry.
  2. Practical evaluation and medical treatment of balance disorders, including:
    1. Electronystagmography/Videonystagmometry.
    2. Dynamic platform posturography.
    3. Sinusoidal harmonic acceleration rotational chair.
    4. High frequency autorotation.
    5. Vestibular rehabilitation, evaluation and treatment.
    6. Epley, Semont maneuver for benign paroxysmal positional vertigo.
    7. Gentamycin injection for ablation of vestibular labyrinth.
  3. Laryngeal framework surgery, vocal fold medialization by injection and airway management by artyenoidectomy/arytenoidopexy.
  4. Airway surgery: bronchoscopy and esophagoscopy.
  5. Indications for open reduction and internal fixation with or without stenting of laryngeal fractures. 
  6. Endoscopic, aerodynamic and electromyographic evaluation voice disorders. Further, the resident should be able to describe the physiologic principles underlying EMG, including muscle and nerve depolarization and its EMG correlates, both visual and auditory.
  7. Laryngeal manifestations of systemic neurologic disease, including Parkinson disease, multisystem atrophy, progressive supranuclear palsy, Charcot-Marie-Tooth, post-polio syndrome, myasthenia, multiple sclerosis, dystonic disorders, tremor, tics and myoclonus.
  8. Medical and surgical treatment of vocal polyps, vocal fold cysts, gastroesophageal reflux and laryngeal dystonia (spasmodic dysphonia). 
  9. Anatomy and physiology of CNS centers of laryngeal control, both cortical and subcortical.
  10. Facial nerve monitoring, ENoG and EMG.
  11. Anatomy and physiology of the orbit, including extraocular muscles, compartments and eyelids.
  12. Mechanisms of orbital fractures, and evaluation and treatment of orbital trauma.
  13. Pathogenesis, evaluation and treatment of orbital tumors.
  14. Recognition, diagnosis and management of primary and secondary (sinus or other etiology) orbital infections.
  15. Evaluation, and medical and surgical treatment of thyroid eye disease.
  16. Reconstruction or restoration of the orbit, lacrimal system and eyelids.
  17. Radiology of the head and neck, including:
    1. Computed tomography of the neck, pharynx, larynx, nasopharynx, salivary glands, and temporal bone.
    2. Magnetic resonance imaging of the neck, pharynx, salivary glands, skull base, and brain.
    3. Positron emission tomography of the head and neck for evaluation of malignant tumors.
    4. Diagnostic and therapeutic angiography of the head and neck.
  18. Complex clinical anatomy of the nose and related structures, including:
    1. The lateral nasal wall, paranasal sinuses, variations in the frontal recess, uncinate process, skull base and pneumatization of the sinuses.
    2. Application of anatomy to interpretation of CT imaging.
    3. Translation of anatomy into the planning and execution of surgical techniques.
  19. The indications and rationale for endoscopic and open approaches to the paranasal sinuses, including:
    1. Assessment of medical treatment prior to surgery, and application of standard and novel (i.e., Mayo inflammatory sinus disease protocol, Allergic Fungal Sinusitis, etc.) therapies after surgery.
    2. Selection of the optimal surgical approach.
    3. Minimizing and treating surgical complications. 
  20. Histopathologic diagnosis of epithelial malignancies, including:
    1. Cutaneous malignancies; squamous cell, basal cell, verrucous and adnexal tumors.
    2. Mucosal epithelial malignancies; squamous cell, verrucous, spindle cell, basaloid squamous, adenosquamous, and adenocarcinoma.
    3. Basics of histochemistry, immunochemistry, flow cytometry and molecular biology.
  21. Histopathologic diagnosis of mesenchymal malignancies, including:
    1. Soft tissue malignancies; malignant lymphoma, rhadomyosarcoma, angiosarcoma, fibrosarcoma, and fibrous histiocytoma.
    2. Basics of histochemistry, immunochemistry, flow cytometry and molecular biology of mesenchymal malignancies.
  22. Histopathologic diagnosis of salivary gland benign and malignant tumors.
  23. Histopathologic diagnosis of thyroid gland benign and malignant tumors.

II. Skill Goals.  Upon completion of this rotation and the academic year, the PGY-4 resident should understand and be prepared for their final training year in the following:

  1. Demonstrate mastery of all skills acquired in the previous two years.

  2. Evaluation of hearing loss, including:

    1. Performing complete air and bone conduction audiogram in normal and hearing impaired patients.

    2. Performing an ABR, otoacoustic emissions audiometry and impedance audiometry.

    3. Interpretation of peripheral and central testing audiometry.

  3. Evaluation of vestibular dysfunction, including:
    1. Performing an ENG.
    2. Assisting in the performance of platform posturography and rotation chair testing. 
  4. The following radiologic skills should be acquired, or improved, during this rotation:
    1. Identification of landmarks within and adjacent to external, middle and inner ear on computed tomographic studies of the temporal bone.
    2. Identification of normal landmarks of the sinonasal cavity, including anterior and posterior drainage pathways on CT.
    3. Identification of normal landmarks on aerodigective tract on sectional imaging studies.
    4. Identification of normal muscular and glandular structures on sectional imaging.
    5. Identification of typical imaging appearances of inflammatory and neoplastic processes on sectional imaging studies of the sinonasal cavity, temporal bone and extracranial head and neck.
  5. The following surgical pathology skills should be acquired during this rotation:
    1. Preparation and interpretation of fine needle aspiration biopsy and frozen section specimen.
    2. Preparation and interpretation of permanent specimens for common benign and malignant tumors of the upper aerodigestive tract.
    3. Preparation and interpretation of permanent specimens for thyroid adenomas, papillary and follicular carcinomas.
    4. Preparation and interpretation of permanent specimens for parotid benign mixed tumor, and mucoepidermoid, adenoid cystic, malignant mixed and acinar cell carcinomas.
  6. 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 as a third-year resident on this rotation at The Eye and Ear.
Procedure CPT-95 Expected Range & (Program Average) for PGY-4, assistant Expected Range & (Program Average) for PGY-4, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Blepharoplasty

15822

1-3 (4.5)

2-4 (3.5)  

0  

Dacryo-
cystorhinostomy

68720

2-5 (2.5)  

3-7 (5.5)  

Direct laryngoscopy, operative

 

 

 

 

With excision of mass or microflap

31541

0 (0.5)  

10-20  

0  

With injection of vocal fold  

31570

0 (0)  

0-2 (0)  

3  

Esophascopy (rigid or flexible)  

43200

0 (1)  

30-40 (46)  

44

Eyelid procedures (i.e., ectropion repair, ptosis, laceration repair)  

15780

15-25 (20) 

10-15 (12)

0  

Eyelid procedures (reconstruction of eyelid by local tissue transfer, flaps)  

 

3-6 (4)  

2-5 (2)  

Not available  

Facial rehabilitation procedures (gold implant to upper eyelid)  

 

0 (0)  

0-2 (2)  

Not available  

Facial rehabilitation procedures (tarsoraphy, lid shortening procedures)  

 

3-7 (5)  

3-5 (3)  

Not available  

Intranasal sinus surgery  

 

 

 

 

- Ethmoidectomy

31254/ 55  

0 (7)  

12-20 (25)  

49

- Maxillary sinusotomy

31256

0 (6)  

15-20 (30)  

51

- Sphenoidotomy

31287/ 88  

0 (4)  

2-6 (9)  

16

- Frontal sinusotomy

31276

0 (3.5)  

1-3 (1)  

8  

Laryngeal EMG

 

 

 

Not available  

Laryngoplasty
Arytenoidectomy  
Thyroplasty

31582
31400
31588

0 (1)  
0 (0.5)  
0 (0.5)  

0-2 (2)  
0-1< (0.5)  
1-5 (2.5)  

5  

Laryngoscopy  
Videostroboscopy

 

0 (0)  

50-70 (60)

Not available  

Orbital decompression  

31292/ 94  

0-2 (0.5)  

1-4 (3)  

0  

Reduction fracture, blowout  

21385/ 2139  

0-2 (2)  

0-2 (8.5)  

4  

Excision of vascular malformation

 

 

20-25

 

TOP

E. Academic 2 (Audiology, Otology, Head and Neck Surgery, Allergy) Service Educational Goals

  1. Third-Year Resident (PGY-4)

    This rotation was begun in July 2010 after the closure of St. Vincent’s Hospital.  It was structured to increase the resident’s exposure to senior level otology at an earlier stage, as well as continue managing Head and Neck patients.  In addition, a formal Allergy exposure has also been incorporated into this rotation.

I. Knowledge Goals.  Upon completion of this rotation and the academic year, the PGY-4 resident should understand and be prepared for their final training year in the following:

  1. Demonstrate mastery of all knowledge acquired in prior years.
  2. Practical evaluation of hearing disorders, including (requirements as modified from Campbell KCM. Audiology Curriculum Guidelines for Otolaryngologists. Am J Audiology. 1995; 4:35-34)
    1. Pure tone audiometry.
    2. Speech audiometry.
    3. Acoustic immittance testing.
    4. Otoacoustic emission testing.
    5. ABR, ASSR, ECogH.
    6. Pediatric audiometry.
  3. Practical evaluation and medical treatment of balance disorders, including:
    1. Electronystagmography/Videonystagmometry.
    2. Dynamic platform posturography.
    3. Sinusoidal harmonic acceleration rotational chair.
    4. High frequency autorotation.
    5. Vestibular rehabilitation, evaluation and treatment.
    6. Epley, Semont maneuver for benign paroxysmal positional vertigo.
    7. Gentamycin injection for ablation of vestibular labyrinth.
  4. Discuss the interpretation of plain radiographs, CT images, MRI/ MRA and 4-vessel arteriographic and venographic images of the temporal bone, base of skull and related structures.
  5. Discuss the diagnosis and medical and/or surgical management of patients with:
    1. Chronic otitis media and cholesteatoma.
    2. Congenital middle ear anomalies.
    3. Congenital and acquired deafness.
    4. Temporal bone fractures.
    5. CSF otorrhea.
    6. Perilymph fistula.
    7. Glomus tympanicum and jugulare.
    8. Acute and chronic dizziness and vertigo.
    9. Auricular atresia.
    10. Primary or metastatic neoplasms of the temporal bone.
    11. Facial paralysis.
  6. Discuss adverse consequences of not treating, potential complications from surgical management of, and long-term management strategies for:
    1. Chronic otitis media and cholesteatoma.
    2. Congenital middle ear anomalies.
    3. Congenital and acquired deafness.
    4. Temporal bone fractures.
    5. CSF otorrhea, purulent otorrhea.
    6. Perilymph fistula.
    7. Glomus tympanicum and jugulare.
    8. Acute and chronic dizziness and vertigo.
    9. Auricular atresia.
    10. Primary and metastatic neoplasms of the temporal bone.
    11. Facial paralysis.
    12. Otosclerosis.
  7. 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. 
  8. 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. Practical evaluation and medical treatment of patients with allergies, including:
    1. Allergy testing
    2. Immunotherapy
    3. Medical management of the allergic patient

II. Skill Goals.

  1. Demonstrate mastery of all skills acquired in the previous three years.
  2. Evaluation of hearing loss, including:
    1. Performing complete air and bone conduction audiogram in normal and hearing impaired patients.
    2. Performing an ABR, otoacoustic emissions audiometry and impedance audiometry.
    3. Interpretation of peripheral and central testing audiometry.
  3. Evaluation of vestibular dysfunction, including:
    1. Performing an ENG.
    2. Assisting in the performance of platform posturography and rotation chair testing. 
  4. The resident must demonstrate ability to manage the General/Head and Neck Surgery patients, including:
    1. 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.
    5. The resident should utilize this third-year rotation at the Eye and Ear to both build upon and acquire new patient management skills as outlined above under Knowledge and those skills required for completion of prior years of training. 

III. Attitude Goals.  See A.1.III and A.3.III.

E. Research Goals

Goals for the research component of resident training are designed to establish competency in the design, conduct, interpretation, and presentation of research by requiring the resident to complete at least one major project on which the resident is the primary investigator and to participate in additional projects on which he/she is a co-investigator. The expected benefit of secondary projects includes the opportunity to enlarge upon previous research and topics identified by senior residents, the opportunity for co-resident mentorship, and opportunities for additional authorships. The research experience is based on a mentorship model. Therefore, the resident and faculty research mentor work together to develop and execute a research project. Effective July 2002, residents are directed to assume a specific, finite role in ongoing basic science projects under established investigators (e.g., elucidate the genetic abnormalities in a metabolic pathway using micro-array analysis which contributes to the development of thyroid cancer in a laboratory which focuses on thyroid neoplasia). Selection of clinical research projects follows a similar protocol; that is, the resident research interest is matched with the appropriate faculty mentor. Faculty research mentors meet every six months as a group to discuss resident research activities, identify individual resident strengths and weaknesses in performing these activities, and develop remediation plans as needed to address weaknesses. Residents submit written evaluations of their faculty research mentors to the research director (Stimson Schantz, M.D.) and department chair at least every six months.

1. Goals for primary research project

I. PGY-2 Goals:

  1. By the end of the third month, the resident will have visited the basic science laboratories and clinical research areas, identified an area of interest, and selected a research mentor.

  2. By the end of the sixth month, the resident will formally declare a research project, enumerate critical design issues with regard to this project (for example, animal versus human subjects, sample size and characteristics, available and required resources, budget), and propose a timetable for completion of the project.

  3. Each resident will be required to present an outline of the research project during the monthly research presentation (Feb/Mar)

  4. By the end of the ninth month, the resident will submit a complete research proposal using the NIH R-01 format and will have obtained IRB approval to begin data collection. The resident will be encouraged to seek extramural funding through the American Academy of Otolaryngology, and other appropriate agencies.

II. PGY-3 Goals:

  1. By the end of the third month of the second year, the resident will have begun data collection and will have made any necessary adjustments to the research design in consultation with research mentor.

  2. By the end of the twelfth month, the resident will have completed a majority of data collection and begun initial data analysis.

  3. 3. Each resident will have a dedicated research day one day out the week from each rotation (Westchester, St. Vincent’s, NYEE)

III. PGY-4 Goals:

  1. The resident will complete data collection.

  2. The resident will complete all data analysis by the end of the dedicated, three-month research rotation.

  3. The resident will work with mentor to prepare an oral and written presentation of results.

  4. The resident will present findings at Resident Research day in June.

IV. PGY-5 Goals:

  1. By the end of the third month of the fourth year, the resident will submit a complete report of the research project to the faculty, and:

    1. Submit a final manuscript for publication in a major scientific or clinical journal.

    2. Submit an abstract of the research report for presentation at a regional, national, or international professional meeting.

    3. May participate with research mentor in preparation of a grant for extramural funding to refine the techniques of grantsmanship.

2. Goals for secondary research projects

I. PGY-2 Goals:

  1. By the end of the third month, the resident will have met with senior residents and faculty to discuss ongoing research projects.

  2. By the end of the sixth month, the resident will have begun assisting a senior resident or faculty member in at least one ongoing research project.

II. PGY-3 through 5 Goals:

  1. Residents will follow the same structure in their second through fourth year as outlined for the primary research project.

TOP

Beth Israel Medical Center

I. Educational Program AT BETH ISRAEL MEDICAL CENTER

Clinical training at Beth Israel consists of one 1st year and one 4th year rotation from NYEE and one 2nd year, one 3rd year and one 4th year from Montefiore. Supervision of residents is based upon a hierarchical system; that is, faculty supervises all residents and all aspects of their training, chief residents supervise junior residents, and residents and faculty supervise medical students and physician assistants. The following table is an overview of resident responsibilities at only Beth Israel and does not include the shared educational program at the Eye and Ear:

Responsibility Day / Time Responsible Resident(s) Responsible Faculty

General Otolaryngology Clinic

Every other Friday, p.m.

 

Dr. Zimbler

Head and Neck Tumor Board

Tuesday, a.m.

1st & 4th year residents

Drs. M. Perksy, M. Urken, D. Buchbinder, T. Tran, A. Jacobson, A. Tabaee, L. Harrison and K. Hu (radiation oncology), B. Wenig (pathology), R. Holliday (radiology)

Head & Neck Clinic

Every other  Tuesday, a.m.

1st & 4th year residents

Dr. Tran

Head & Neck OR

Monday, all day

1st & 4th year residents1st & 4th year residents

Drs. Urken, Buchbinder

Head & Neck OR

Tuesday

1st & 4th year residents

Drs. Urken, Buchbinder

Head & Neck OR

Wednesday, all day

1st & 4th year residents 135residents

Dr. Tran

Pediatric Head and Neck Surgery

Wednesday, all day

3rd year Academic rotation resident from NYEE

Drs. M. Waner, R. Dyleski

Head & Neck OR

Thursday, all day

1st & 4th year residents

Drs. Urken, Buchbinder

Teaching Rounds

Every other Thursday

All residents

Drs. Tran, Urken, Buchbinder, Jacobson

Head & Neck OR

Friday, all day (occasional)

1st & 4th year residents

Drs. Tran

 

TOP

A. First-Year Resident (PGY-2)

Upon completion of this rotation  at Beth Isreal Medical Center the PGY-2 resident will have:

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, with a focus 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 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.Diagnostic evaluation and plan of investigation.
    3. 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.
    4. The extent of the various partial laryngectomies, including supraglottic, vertical hemi-, and supracricoid 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. Describe the anatomy, presenting symptoms, regional neoplasms, and imaging evaluation of tumors of the anterior, middle and posterior skull base. 
  29. Discuss concepts relevant to surgical repair of facial defects and deformities, including:
    1. Temporal sequence of events in wound healing.
    2. Biochemical and cellular events of normal and disordered wound healing.
    3. Mechanisms of bone healing.
    4. Principles of local, regional, myocutaneous and free-flap reconstruction of head and neck surgical wounds. 

II. Skill Goals.  First-year Otolaryngology 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. 
  3. Perform a complete head and neck history and physical examination in both the adult and pediatric Intensive Care Units (Cardiology ICU, Medicine ICU, Neonatal ICU, Neurosurgical ICU, Pediatric ICU, Pulmonary ICU, Surgical ICU) and emergency room settings.
  4. Perform consultative services in an acute care hospital.
  5. Manage acute airway problems in children and adults.
  6. Conduct a differential diagnosis for common presenting signs and symptoms of connective tissue and granulomatous diseases of the head and neck.
  7. Demonstrate knowledge of fluid and electrolytes in the perioperative care of the head and neck surgical patient.
  8. Demonstrate knowledge of the hematologic coagulation cascade to the perioperative care of the head and neck surgical patient.
  9. Describe the classification of inflammatory diseases of cervical lymph nodes, the histoarchitecture of cervical lymph nodes including architecture associated with inflammatory diseases. 
  10. Construct a differential diagnosis of patient presenting with inflammatory diseases of the cervical lymph nodes.
  11. Conduct a differential diagnosis and evaluation for abnormal enlargement of the salivary glands.
  12. Identify the clinical presenting signs and symptoms of oral cavity cancer including the physiologic and anatomic basis of these clinical conditions. 
  13. Assess cranial nerve deficits in oropharyngeal, oral cavity, and laryngeal cancers.
  14. 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. 
  15. Identify the clinical presenting signs and symptoms of nasopharynx cancer including the physiologic and anatomic basis of these clinical conditions.
  16. Assess cranial nerve and skull base deficits related to nasopharynx cancer.
  17. Identify the clinical presenting signs and symptoms of oropharyngeal, hypopharyngeal and laryngeal cancers, including the physiologic and anatomic basis of these clinical conditions. 
  18. Conduct a comprehensive assessment of esophageal physiology and esophageal disease.
  19. Perform pre-operative and post-operative assessment, and management of the patient undergoing pediatric, rhinologic, laryngologic and head and neck surgical procedures.
  20. Explain risk factors in the preoperative assessment of surgical patients.
  21. Perform long-term evaluation and management of the head and neck surgical patient.
  22. Perform local skin flaps in reconstruction of Mohs surgery defects. 
  23. Describe regional, myocutaneous and free flap principles sufficiently to participate in the designing of such flaps for the reconstruction of surgical wounds.
  24. Progress through outpatient clinic or emergency procedures under direct supervision of faculty as follows, but not limited to:
Procedure Minimal Number Required Cumulative Program Average for PGY-2 Comment

Anterior nasal pack/ posterior nasal pack  

5

10

Residents initially perform these procedures under direct faculty supervision.  After demonstrating competence as judged by the faculty, the resident may be directly supervised by a chief resident, with the faculty present in the clinic.

Cautery of nose  

0

3

Closed reduction nasal fracture  

0

2

Fine needle biopsy  

3

6

Flexible laryngoscopy

70

100

Incision & drainage peritonsillar abscess  

2

5

Incision & drainage superficial soft tissue abscess(face, neck, septum)  

0

3

Primary closure of traumatic facial, ear and neck lacerations  

0  

2

Removal foreign body ear, nose

2

5

Microscopic exam ear  

20

30

Myringotomy

0

5

Trach tube change

10

20

TOP

  1. Perform standard techniques: 
    1. Incision placement for selected procedures.
    2. Surgical flap elevation. 
    3. Wound closure and management. 
    4. Surgical dissection and hemostasis.
    5. Surgical wound drainage.
  2. Function as first assistant on major head and neck surgical procedures.
  3. Perform ambulatory and inpatient surgical procedures. The following operations are a modification of the RRC key procedures specifically for the Beth Israel rotation, and serve as minimal technical skill goals for this phase of training (Numbers are reported as the range of expected procedures for this rotation):
Procedure CPT-95 Expected Range & (Program Average) for PGY-2, assistant Expected Range & (Program Average) for PGY-2, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Adenoidectomy

42830

0 (1)  

3-10 (116.5)  

40

Angiofibroma/ vascular neoplasm, excision  

30118

0-2 (1.5)  

0 (0)  

1.75  

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision  

42815, 60280, 30124/ 30125, 38555, 38550  

0-1 (5)  

1-3 (5.5)  

9

Bronchoscopy, diagnostic  

31622, 31635, 31630  

0 (0.75)  

0-3 (0.75)  

59 (panendo on all CA pts)  

Cervical Mass Biopsy  

38510

0-3 (3.5)  

2-5 (4)

17.5

Composite resection

41155, 41155.52

0-2 (0.5)

0 (0)  

7  

Craniofacial/ Anterior skull base resection  

61580.615  

0-2 (0.25)  

0 (0)  

1.25  

Direct laryngoscopy, adult  

31525, 31541  

0 (5)  

2-8 (6)  

74  

Direct laryngoscopy, pediatric  

31520, 31530

0 (0.5)  

0-2 (0.5)  

8.5 (Increase time with Dr. Dyleski, Mon a.m.)  

Esophagoscopy

43200, 43215

0-2 (2)  

0-3 (0.5)  

54  

Hemilaryngectomy, vertical  

31370

0-2 (0)  

0 (0)  

1  

Hemilaryngectomy, horizontal  

31367

0-2 (0)  

0 (0)  

0.8  

Incision and Drainage deep neck abscess  

21501

0-2 (1)  

0-2 (1)  

12  

Laryngectomy, Total  

31360

0-2 (1.75)  

0 (0)  

4

Laryngo-
pharyngectomy  

31390

0-1 (0.5)  

0 (0)  

1.5  

Laryngoplasty/ Arytenoidectomy/ Thyroplasty  

31582, 31400, 31588  

0-2 (0.25)  

0 (0)  

7  

Maxillectomy

31225.52, 31225, 31230  

0-4 (3)

0 (0)  

5  

Neck dissection

38720, 38724, 38724.52  

3-10 (8)  

0 (0)  

42  

Oral Cavity tumor, local resection/ glossectomy  

41112, 41120, 41130, 41140  

3-5 (4.5)  

0-2 (2)  

16  

Parathyroidectomy

60500

1-5 (8)  

0 (0)  

4  

Parotidectomy

42415, 42420, 42425  

1-5 (3)  

0 (0)  

18  

Pharyngo-
esophagectomy

43107

0-2 (0)  

0 (0)  

0.5  

Reconstruction flaps, local  

14040, 14020  

0-5 (2)  

0-3 (0)  

13  

Reconstruction flaps, muscle fasciocutaneous  

15732

1-3 (1)  

0 (0)  

7

Reduction facial fracture, frontal  

21343

0-2 (0)  

0 (0)  

2  

Reduction facial fracture, malar  

21356/ 21366  

0-2 (0.5)  

0 (0)  

7  

Reduction facial fracture, mandible  

21453, 21454/ 21470  

0-2 (0.5)  

0 (0)  

17.5 (increase dedicated OR time w/oral surgery service) 

Reduction facial fracture, nasal  

21310/ 21036  

0-2 (1.5)  

0-2 (3)

10.5  

Reduction facial fracture, orbital  

21385

0-2 (0)  

0 (0)  

5  

Repair, CSF Rhinorrhea  

n/a  

0-3 (n/a)  

0 (n/a) 

n/a  

Scar Revision  

12001/ 1813131/ 52

0-3 (2)  

0-3 (4)  

22  

Sinus, antrostomy  

31020

0-3 (4.5)  

0 (0)  

57.5  

Sinus, ethmoid  

31200

0-3 (4.5)  

0 (0)  

56

Sinus, frontal  

31276

0-3 (2)

0 (0)  

13

Sinus, sphenoid  

31050

0-3 (2.75)  

0 (0)  

20  

Sinus, frontal, osteoplastic

31084, 31086  

0-2 (1)  

0 (0)  

2.8  

Surgical speech fistula (TEP)  

31611  

0-3 (1)  

0 (0)  

5  

Submandibular gland excision  

42440

1-3 (1.5)  

0 (0)  

9  

Tonsillectomy

42825.52, 42825.50

0 (3)  

3-8 (95)  

0  

Thyroidectomy

60220, 60225, 60240  

3-8 (8)

2-5 (5)  

26.5  

Tracheotomy

31600

0 (3.5)  

6-15 (9.5)  

70.5  

TOP

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 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 net working. Demonstrate behaviors that reflect an ongoing commitment to continuous professional development, ethical practice, sensitivity to diversity, and responsible attitudes.
  13. Use survey procedures to complete a 360-degree examination of leadership and produce an action plan with a faculty mentor to improve identified deficiencies.
  14. Demonstrate habitual self-assessment to evaluate self-image and assumptions.
  15. Show evidence of intermediate and long term planning for professional development.
  16. Record all tasks that need to be accomplished and ensure that they are completed in a timely manner.
  17. 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.
  18. Show evidence of implementation of a networking system.
  19. Show a system (card, computer, etc.) to record information about professional contacts.
  20. Maintain a personal operative record database.
  21. Demonstrate insight into personal character and temperament and how they impact work.

TOP

B. Second Year Resident (PGY-4)

I. Knowledge Goals. The second-year resident at Beth Israel should acquire increased knowledge of Head and Neck Surgery, Facial Plastics, Sinus Disease, Otolaryngologic emergency care and Pediatric Otolaryngology. 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 second-year resident should:

  1. Demonstrate mastery of all knowledge acquired in the prior years.
  2. Describe the preoperative selection, operative and perioperative care, and avoidance and management of complications of patients on the General/Head and Neck Surgery Service. Although they should have the same knowledge as their peers, during this rotation they should focus this knowledge on:
    1. Drainage of deep neck abscess.
    2. Endoscopy of the esophagus, larynx, sinuses and trachea.
    3. Endoscopic antrostomy, ethmoidectomy, frontal sinusotomy and sphenoidotomy.
    4. External approaches to the paranasal sinuses; Caldwel Luc, ethmoidectomy, ligation of the internal maxillary artery, osteoplastic frontal sinusotomy and trephination.
    5. Reconstruction of surgical wounds using local, regional, distant and free flaps.
    6. Preparation and interpretation of fine needle aspiration biopsy and frozen section specimen.
    7. Preparation and interpretation of permanent specimens for common benign and malignant tumors of the upper aerodigestive tract.
    8. Preparation and interpretation of permanent specimens for thyroid adenomas, papillary and follicular carcinomas.
    9. Preparation and interpretation of permanent specimens for parotid benign mixed tumor, and mucoepidermoid, adenoid cystic, malignant mixed and acinar cell carcinomas.
    10. Evaluation and management of patients undergoing Radiation therapy for malignant Head and Neck neoplasms.

II. Skill Goals. The second-year Otolaryngology resident at Beth Israel will build upon their first-year skills and demonstrate new skills as follows, but not limited to those outlined below:

  1. Conduct a complete office-based physical exam of the head and neck, including assisting medical students in the teaching clinic.
  2. Demonstrate advanced skills in the performance of indirect mirror and flexible laryngoscopy.
  3. Demonstrate 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. Develop medical and surgical management plans for diseases of the major and minor salivary glands.
  5. Perform endoscopic procedures of the upper aerodigestive tract, including rigid laryngoscopy, esophagoscopy, and bronchoscopy.
  6. Conduct diagnostic assessments (e.g., staging endoscopy, CT, MRI and PET imaging, and FNA) and capitulate staging parameters of squamous cell and non-squamous cell neoplasms of the head and neck. Demonstrate these skills in presentation of patients to Head and Neck Tumor Board, and understand the relationship between clinical stage and prognosis.
  7. Demonstrate consultative skills in evaluation and treatment of ICU and emergency room patients.
  8. Manage blunt and penetrating trauma to the head and neck, both hard and soft tissue. 
  9. Demonstrate the ability to initially manage patients with general trauma, and to evaluate and stabilize acute injuries to the head and neck. 
  10. Demonstrate a working knowledge of the mechanisms of carcinogenesis of upper aerodigestive cancers as well as the critical elements of cellular dysregulation and metastases. 
  11. Discuss the measures of immune suppression in head and neck cancer and their biologic basis. Utilize these principles to counsel patients about prognosis, risk factors and life style.
  12. Demonstrate a working understanding of the use of diagnostic procedures for diseases of the esophagus including the identification of abnormalities involving manometry, ph monitoring, and esophagoscopy.
  13. Apply knowledge of multi-organ system risk factors towards the management of postoperative complications.
  14. Construct a differential diagnosis for clinically identified lesions of the head and neck including, nasopharynx, nasal cavity, paranasal sinuses, oral cavity, pharynx, and larynx. 
  15. Understand the use of radiation therapy in the management of head and neck carcinoma
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. Improve ability to manage and maintain efficiency of team. 
    1. Meet regularly with surgical teaching staff for guidance and discussion of issues arising from the running of the team.
  3. Develop 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.
    1. Describe a variety of coping reactions that are commonly employed by patients with life-threatening illnesses. 
    2. Describe an appropriate therapeutic response for each of the common coping reactions that are employed by patients with life-threatening illnesses.
  4. Develop skill in dealing with the psychosocial dimension of head and neck oncology:
    1. Describe the ethical issues that are involved in the treatment of patients with life-threatening illnesses.
    2. Effectively communicate with patients and their families. 
  5. Develop an understanding and appreciation of the importance of networking in the professional environment and how it can facilitate optimal patient care:
    1. Discuss the rationale for networking in the professional environment.
    2. Give examples of networking
  6. Demonstrate behaviors that reflect an ongoing commitment to continuous professional development, ethical practice, sensitivity to diversity, and responsible attitudes.
  7. Use survey procedures to complete a 360-degree examination of leadership and produce an action plan with a faculty mentor to improve identified deficiencies.
  8. Enhance the habit of self-assessment to evaluate self-image and assumptions.
  9. Show evidence of intermediate and long term planning for professional development.
  10. Demonstrate the habit of recording all tasks that need to be accomplished and ensuring that they are completed in a timely manner.
  11. Have 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.
  12. Show evidence of implementation of a networking system.
  13. Show a system (card, computer, etc.) to record information about professional contacts.
  14. Demonstrate continued maintenance of a personal operative recording database.
  15. Initiate the habit of self-assessment by gaining insight into personal character and temperament and how they impact work.
  16. Develop the habit of recording all tasks that need to be accomplished and of ensuring that they are completed in a timely manner.

C. Fourth Resident (PGY-5)

I. Knowledge Goals.  The fourth-year resident at Beth Israel 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 fourth-year resident at Beth Israel should:

  1. Demonstrate mastery of all knowledge acquired in the prior years.
  2. Describe the preoperative selection, operative and perioperative care, and avoidance and management of complications of patients on the General/Head and Neck Surgery Service. Although they should have the same knowledge as their peers, during this rotation they should focus this knowledge on:
    1. Airway surgery; larygoplasty, palatoplasty, tracheotomy.
    2. Drainage of deep neck abscess.
    3. Endoscopy of the esophagus, larynx, sinuses and trachea. 
    4. Endoscopic antrostomy, ethmoidectomy, frontal sinusotomy and sphenoidotomy.
    5. External approaches to the paranasal sinuses; Caldwel Luc, ethmoidectomy, ligation of the internal maxillary artery, osteoplastic frontal sinusotomy and trephination.
    6. Excision of congenital cysts and sinuses (branchial cleft, thyroglossal duct).
    7. Laryngeal fractures, with open reduction and internal fixation with or without stenting.
    8. Laryngeal framework surgery, vocal fold medialization by injection and airway management by artyenoidectomy/arytenoidopexy.
    9. Laryngectomy; total, horizontal, supraglottic and supracricoid.
    10. Maxillectomy; medial and total with and without orbital exeneration.
    11. Neck dissection, modified and radical.
    12. Marginal and segmental mandibular resection.
    13. Parotidectomy, resection of parapharyngeal space and submandibular gland neoplasms.
    14. Repair of CSF rhinorrhea; endoscopic and external approaches.
    15. Repair of blunt and penetrating injuries to the face and neck, both hard and soft tissue injuries.
    16. Resection of neoplasms of the upper aerodigestive tract.
    17. Resection of vascular tumors and anomalies.
    18. Reconstruction of surgical wounds using local, regional, distant and free flaps.
    19. Skull base surgery.
    20. Thyroidectomy, parathyroidectomy.
    21. Vascular surgery; resection of carotid body tumors, repair of venous and arterial lacerations and ligation of major vessels of the head and neck.
  3. Describe the range of treatment modalities for benign and malignant disease of the head and neck. 

II. Skill Goals.  The resident must demonstrate ability to manage the Head and Neck Surgery Service at Beth Israel. These skills should include:

  1. Supervise junior residents and coordinate nursing, social services and administration to optimize patient care.

  2. Assist faculty with supervision of the outpatient clinics, consultations, and emergency room care of patients.

  3. Develop the treatment plan for all patients undergoing medical or surgical care on this service and direct the presentation of appropriate patients to the Head and Neck Tumor Board.

  4. Complete this phase of their training at Beth Israel by demonstrating competence in ambulatory and inpatient surgical experience as consistent with programmatic and national standards for the following procedures:

Procedure CPT-95 Expected Range & (Program Average) for PGY-5, assistant Expected Range & (Program Average) for PGY-5, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Angiofibroma/ vascular neoplasm, excision

30118

0-2 (0.4)

0-2 (0.8) 

1.75

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision

42815, 60280, 30124/ 30125, 38555, 38550

0 (8.4)

0-3 (18.8)

9

Bronchoscopy, diagnostic

31622, 31635, 31630

0 (5.8)

2-5 (34.8)

59 (bronch all CA pts)

Composite resection

41155, 41155.52

0 (3.8)

0-3 (6.4)

7

Craniofacial/ Anterior skull base resection

61580.615

2-5 (7.2)

0 (0.8)

1.25

Direct laryngoscopy, adult

31525, 31541

0 (9.2)

2-8 (108.4)

74

Direct laryngoscopy, pediatric

31520, 31530

0 (0.8)

0-2 (6.8)

8.5

Esophagoscopy

43200, 43215

0 (1.2)

1-3 (34.2)

54 (panendo all CA pts)

Hemilaryngectomy, vertical

31370

0 (0.8)

0-2 (0.2)

1

Hemilaryngectomy, horizontal

31367

0 (1.4)

0-2 (1.2)

0.8

Incision and Drainage deep neck abscess

21501

0 (0.8)

0-2 (9.6)

12

Laryngectomy, Total

31360

0 (6)

0-3 (3.2)

4

Laryngo-
pharyngectomy

31390

0 (1.4)

0-1 (0.4)

1.5

Laryngoplasty/ Arytenoidectomy/ Thyroplasty

31582, 31400, 31588 

0 (3)

0-3 (3.6)

7 (Increase OR time w/Dr. Sulica)

Maxillectomy

31225.52, 31225, 31230

0 (5.8)

2-4 (6.8)

5

Neck dissection

38720, 38724, 38724.52

0 (21.8)

5-15 (31.2)

42

Oral Cavity tumor resection/ glossectomy

41112, 41120, 41130, 41140

0 (6.6)

3-5 (15.8)

16

Parathyroidectomy

60500

0 (5.4)

3-10 (15.6)

4

Parotidectomy

42415, 42420, 42425

0 (17)

3-10 (20)

18

Pharyngo-
esophagectomy

43107

0 (1.25)

0-1 (0.4)

0.5

Reconstruction flaps, local

14040, 14020

0 (8.6)

0-5 (12.8)

13

Reconstruction flaps, muscle fasciocutaneous

15732

0 (8.8)

1-4 (7.2)

7

Reduction facial fracture, frontal

21343

0 (1)

0-2 (3)

2

Reduction facial fracture, malar

21356/ 21366

0 (5)

0-2 (5)

7 (educate ER to call for trauma consults)

Reduction facial fracture, mandible

21453, 21454/ 21470

0 (5)

0-2 (5)

17.5 (increase time w/ oral surgery)

Reduction facial fracture, nasal

21310/ 21036

0 (4.6)

0-2 (12.6)

10.5

Reduction facial fracture, orbital

21385

0 (2.8)

0-2 (3)

5

Repair, CSF Rhinorrhea

n/a 

0-3 (n/a)

0-1 (n/a)

n/a 

Scar Revision

12001/18, 13131/52

0 (2.6)

0-3 (9.2)

22

Sinus, antrostomy

31020

0 (14.4)

0-5 (40.6)

57.5

Sinus, ethmoid

31200

0 (14.2)

0-5 (40.2)

56

Sinus, frontal

31276

0 (5.2)

0-3 (8.8)

13

Sinus, sphenoid

31050

0 (7.6)

0-3 (14.4)

20

Sinus, frontal, osteoplastic

31084, 31086

0 (3.4)

0-2 (6.4)

2.8

Surgical speech fistula (TEP)

31611

0 (0.8)

0-5 (4.8)

5

Submandibular gland excision

42440

0 (3.8)

1-5 (11.2)

9

Thyroidectomy

60220, 60225, 60240

0 (39.6)

10-15 (74)

26.5

Tracheotomy

31600

0 (5.6)

0-5 (77.4)

70.5

Free Microvascular Flap

 

(12)

 

 

TOP

III. Attitude Goals.  At the completion of the fourth year of training, the resident should both demonstrate the attitudes noted for the previous years of training and have developed the professionalism necessary to direct the care of patients with complex head and neck, pediatric, rhinologic and laryngologic disorders. The latter at a minimum should include:

  1. Care for patients with terminal disease, and assisting their families with such problems by:
    1. Applying an understanding of psychosocial aspects of dying to assist patients and their care givers in the patient's appropriate placement for terminal care (i.e., home or hospice).
    2. Assist in identifying appropriate professionals to care for the non-otolaryngologic needs of the patient.
  2. Adopt the attitude that the physician is the health care advocate of the patient despite the current obstacles to maintaining the traditional patient-physician relationship

TOP

Westchester Medical Center

I. Educational Program AT WESTCHESTER MEDICAL CENTER

Clinical training at Westchester consists of two 2nd year and one 3rd year rotations. The senior resident functions as the chief or administrative resident for this service. Supervision of residents is based upon a hierarchical system; that is, faculty supervises all residents is all aspects of training, chief residents supervise junior residents, and residents and faculty supervise medical students and physician assistants. The following table is an overview of resident responsibilities at only Westchester Medical Center and does not include the shared educational program at the Eye and Ear:

Responsibility Day / Time Responsible Resident(s) Responsible Faculty

Head & Neck OR  

Monday, all day

2nd & 3rd year residents

Drs. A. Moscatello, C Honrado  

Pediatric OR  

Monday, a.m.  

2nd or 3rd year residents

Dr. D. Merer  

Pediatric Clinic  

Monday, p.m.  

2nd year resident  

Drs. D. Merer and DeSerres  

Head & Neck OR  

Tuesday, all day

2nd or 3rd year resident

Dr. A. Damiano  

Pediatric OR

Friday, p.m., twice monthly  

2nd year resident  

Dr. A. Moscatello  

Otology OR  

Tuesday, all day

2nd or 3rd year resident  

Dr. DeSerres

Head & Neck Clinic  

Tuesday, p.m.  

2nd year resident  

Drs. C. Zalvan, C. Honrado, S. Hemmerdinger  

Head & Neck OR  

Wednesday, all day  

2nd or 3rd year resident  

Drs. A. Moscatello and C. Zalvan  

Pediatric OR  

Thursday, all day  

2nd or 3rd year resident  

Dr. D. Merer

General or Head & Neck OR  

Thursday, all day  

2nd & 3rd year resident

Dr. A. Damiano  

Otology/Neuro-otology Clinic  

Thursday, p.m.  

2nd year resident  

Dr. L. Meiteles  

Head & Neck OR  

Friday, all day  

2nd & 3rd year resident

Drs. A. Moscatello and S. Hemmerdinger

Head & Neck Clinic-Taylor Care Center

Friday, a.m., twice monthly  

2nd & 3rd year resident

Drs. A. Damiano, C. Honrado or C. Zalvan

 

TOP

A. Second-Year Resident (PGY-3)

I. Knowledge Goals.  The second-year resident at Westchester Medical Center should build upon the prior year educations goals and demonstrate further knowledge in the following areas specific to this rotation, including:

  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 intraoperative 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 genetic basis of cell cycle dysregulation in cancers of the head and neck.

  15. Define critical cellular components in the metastatic process. 

  16. Describe laboratory-based immunologic parameters associated with head and neck cancer. 

  17. Describe factors associated with immune depression and escape by head and neck cancer. 

  18. Explain the classification schemes for cervical lymph node metastases i ncluding AJCC classification schemes.

  19. Define the AJCC staging parameters of cancers of the upper aerodigestive tract including cancers of the nasopharynx, paranasal sinuses, oral cavity, pharynx, and larynx.

  20. Describe the assessment and diagnostic evaluation of patients with diseases of the oral cavity.

  21. Explain the histopathologic classification systems of oral cavity cancer. 

  22. Discuss the diagnostic evaluation and staging of oral cancers.

  23. Describe the diagnostic characteristics, histopathologic characteristics, and natural history of benign lesions of the oral cavity including odontogenic tumors.

  24. Describe the histopathologic classification systems of oropharynx cancer.

  25. Discuss the current methodology for assessing speech and swallowing disorders.

  26. Describe the techniques for post-operative rehabilitation of swallowing function in the patient treated for head and neck cancer.

  27. Discuss the diagnostic considerations, histopathology, clinical course of acquired and congenital lesions of the larynx and hypopharynx.

  28. Explain the principles of medical and surgical treatment of gastroesophageal reflux disease.

  29. Explain sensitivity, specificity, and limitations relevant to the diagnostic tests for the thyroid nodule. 

  30. Describe histopathologic conditions related to the thyroid nodule.

  31. Describe classification schemes for benign diseases of the major and minor salivary glands. 

  32. Describe the differential diagnosis of enlargement of the parotid gland.

  33. Discuss the assessment and diagnostic evaluation of patients with diseases of the major and minor salivary glands.

  34. Explain the epidemiology of malignant diseases of the major and minor salivary glands. 

  35. Describe the istopathologic characteristics of salivary gland neoplasias.

  36. Describe the histopathologic characterization, diagnostic, and radiographic characteristics of connective tissue and granulomatous diseases of the head and neck.

  37. Explain the diagnosis and management of deep space infections of the head and neck.

  38. Define the causes of lymphadenitis, both viral and non-viral. 

  39. Describe the noninfectious causes of lymphadenopathy, including lymphadenopathy associated with systemic illness.

  40. Describe the diagnostic evaluation of obstructive sleep apnea including physiologic sleep studies, sleep disorder scales, and radiographic assessments. 

  41. Discuss the role and characteristics of non-surgical management of sleep apnea.

  42. Discuss the etiology, diagnostic considerations, histopathology, and clinical characteristics of vascular anomalies of the head and neck. 

  43. Discuss the pathogenesis and treatment of neuroendocrine lesions of the head and neck including glomus and carotid body tumors.

  44. Describe the surgical anatomy of the temporal bone and related structures, with a focus on the clinical relevance of anatomical structures, their physiology and their relationship to disease management, including:a) Biomechanics of the external and middle ear in hearing.

    1. Biomechanics of the inner ear, neural processing by the cochlear nerve and brain.

    2. Biomechanics of the vestibular system, neural processing of the vestibular nerve and brain.

    3. Etiology and consequences of genetic hearing loss.

  45. Describe the natural history, clinical presentation, evaluation, and treatment of otitis media, including:
    1. Antibiotic and surgical options.
    2. Role of tympanostomy tubes and adenoidectomy.
    3. Epidemiology of otitis media and consequences of delayed or inadequate treatment.
  46. Discuss general management of the trauma patient.
  47. Describe the evaluation and management of facial skeleton, sinuses and mandibular fractures.
  48. Discuss the clinical, radiographic and vestibular/hearing findings in longitudinal versus horizontal temporal bone fractures. 
  49. Explain the associated neurological injuries and their management.
  50. Describe the ballistics and principles of penetrating trauma.
  51. Discuss the evaluation and management of penetrating trauma to soft tissue of the face and salivary glands.
  52. Describe the potential injuries for specific zones of the neck, their evaluation and treatment (including vascular, neurological and airway).
  53. Describe the pre-operative evaluation and decision process for:
    1. Simple mastoidectomy and canal wall up versus canal wall down mastoidectomy.
    2. Middle ear reconstruction.
    3. Labyrinthectomy, endolymphatic shunt and vestibular nerve sectioning.
    4. Middle fossa, translabyrinth and retrosigmoid removal of acoustic neuroma.
  54. Discuss regional, myocutaneous and free flap principles sufficiently to design such flaps for the reconstruction of surgical wounds.
  55. Describe the evaluation and management of pediatric patients with airway disorders, such as laryngeal papillomatosis, epiglottis, subglottic stenosis and laryngomalacia.
  56. Discuss congenital airway disorders in relation to the embryology and development of the larynx and trachea.

II. Skill Goals. The second-year Otolaryngology resident at Westchester will build upon their first-year skills and demonstrate new skills as follows, but not limited to those outlined below:

  1. Conduct a complete office-based physical exam of the head and neck, including assisting medical students in the teaching clinic.

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

  3. Demonstrate 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. Develop medical and surgical management plans for diseases of the major and minor salivary glands.

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

  6. Perform endoscopic procedures of the upper aerodigestive tract, including rigid laryngoscopy, esophagoscopy, and bronchoscopy.

  7. Conduct diagnostic assessments (e.g., staging endoscopy, CT, MRI and PET imaging, and FNA) and capitulate staging parameters of squamous cell and non-squamous cell neoplasms of the head and neck. Demonstrate these skills in presentation of patients to Head and Neck Tumor Board, and understand the relationship between clinical stage and prognosis.

  8. Demonstrate consultative skills in evaluation and treatment of ICU and emergency room patients.

  9. Manage blunt and penetrating trauma to the head and neck, both hard and soft tissue. 

  10. Demonstrate the ability to initially manage patients with general trauma, and to evaluate and stabilize acute injuries to the head and neck. 

  11. Demonstrate progressive competence in the above skills and in new skills during the second-year rotation at Westchester by meeting the following goals:

Second-Year Resident Goals during Westchester Rotation Specific Expectations for this Goal

Acute airway evaluation, adult in ICU or ER  

Resident rounds should include the MICU, CCU, NICU, Respiratory ICU and SICU. Consultative services should include complete evaluation of the airway, including endoscopy as required. Residents should anticipate 5-10 such consults per week. Residents should anticipate caring for 5-10 acute airway emergencies from the ER during this rotation.

Acute airway evaluation, pediatric in ICU or ER  

Resident rounds should include the pediatric ICU and NICU. Consultative services should include complete evaluation of the airway. Residents should anticipate 1-3 such consults per week. Residents should anticipate caring for 2-10 acute airway emergencies from the ER during this rotation.  

Anterior nasal pack/ posterior nasal pack  

Resident should provide consultative services to the entire hospital and learn to manage both outpatients and inpatients with epistaxis.  

Facial fractures  

Residents should see both outpatients and inpatients for facial fractures. They should anticipate caring for: 0-5 nasal fractures, 0-5 dental fractures, 0-5 maxillary fractures, 0-5 orbital fractures, 0-2 frontal fractures and 0-5 mandibular fractures during this rotation. They should observe, assist and perform application of standard and compression plates for facial fractures.

Incision & drainage peritonsillar abscess  

Residents should anticipate caring for 2-10 such cases during this rotation.

Incision & drainage superficial soft tissue abscess (face, neck, septum)  

Residents should anticipate caring for 0-5 such cases during this rotation.  

Primary closure of traumatic facial, ear and neck lacerations  

Residents should anticipate caring for 10-25 such cases during this rotation.  

Trach tube change 

Residents should anticipate 5-10 such consults per week.  

TOP

  1. Demonstrate a working knowledge of the mechanisms of carcinogenesis of upper aerodigestive cancers as well as the critical elements of cellular dysregulation and metastases. 

  2. Discuss the measures of immune suppression in head and neck cancer and their biologic basis. Utilize these principles to counsel patients about prognosis, risk factors and life style.

  3. Demonstrate a working understanding of the use of diagnostic procedures for diseases of the esophagus including the identification of abnormalities involving manometry, ph monitoring, and esophagoscopy.

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

  5. Construct a differential diagnosis for clinically identified lesions of the head and neck including, nasopharynx, nasal cavity, paranasal sinuses, oral cavity, pharynx, and larynx. 

  6. Manage acute and chronic airway obstruction in both adults and children, including:

    1. Differentiating, evaluating and managing dyspnea, stridor and stertor.

    2. Adult and pediatric epiglottis, angioneurotic edema and croup.

    3. Acquired and congenital subglottic stenosis.

    4. Immobile vocal folds due to either paralysis or fixation.

  7. Surgically manage anterior, middle and posterior fossa tumors. 
  8. Participate in the discussion of the management of skull base tumor patients at Neurosurgery/Skull Base Conference.
  9. Manage regional and systemic infectious and inflammatory diseases involving the head and neck, including:
    1. Syphilis, tuberculosis, lyme disease, HIV, and CMV.
    2. Bacterial and fungal sinusitis (rhinosinusitis).
    3. Rheumatoid arthritis, granulomatous disease and autoimmune disorders. 
  10. Increase ambulatory and inpatient surgical skills. The second-year Otolaryngology resident at Westchester should complete the following operative goals as part of their PGY-3 training (Numbers are reported as the range of expected procedures for this rotation):
Procedure CPT-95 Expected Range & (Program Average) for PGY-3, assistant Expected Range & (Program Average) for PGY-3, surgeon Average, American Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Adenoidectomy

42830

0 (0)  

2-5 (125.5)  

40  

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision  

42815, 60280, 30124/ 30125, 38555, 38550

0 (1.5)  

0-3 (8.5)  

9  

Bronchoscopy, diagnostic  

31622, 31635, 31630  

0 (2.25) 

2-5 (19)  

59 (panendo all CA pts)  

Cervical Mass Biopsy  

38510

0 (3.5)  

3-7 (18.25)  

17.5  

Composite resection

41155, 41155.52  

0-2 (3.75)  

0 (0.5)  

7  

Craniofacial/ Anterior skull base resection  

61580.615  

0-1 (0.25)  

0 (0)  

1.25  

Direct laryngoscopy, adult  

31525, 31541  

0 (3.5)  

8-15 (49)  

74  

Direct laryngoscopy, pediatric

31520, 31530

0 (0)  

1-4 (1.5)

8.5  

Esophagoscopy

43200, 43215  

0 (1.75)  

2-5 (19)  

54

Hemilaryngectomy, vertical  

31370

0-1 (1.25)  

0 (0.25)  

1

Hemilaryngectomy, horizontal  

31367

0-1 (0.25)  

0 (0.25)  

0.8  

Incision and Drainage deep neck abscess

21501

0-2 (0.25)  

0-2 (3.75)  

12  

Laryngectomy, Total  

31360

0-1 (2.5)  

0 (0.25)  

4  

Laryngo-
pharyngectomy

31390

0-1 (0.5)  

0 (0)  

1.5  

Laryngoplasty/ Arytenoidectomy/ Thyroplasty  

31582, 31400, 31588  

0-2 (3.5)  

0-2 (2)  

7 (more office/bedside injection medializations w/Dr. Zalvan)  

Maxillectomy

31225.52, 31225, 31230

0-2 (4)  

0-1 (0.75)  

5  

Neck dissection

38720, 38724, 38724.52  

2-5 (21)  

0-1 (3)  

42  

Oral Cavity tumor resection/ glossectomy  

41112, 41120, 41130, 41140

2-5 (5.25)  

0-2 (7)  

16

Parathyroidectomy

60500

2-5 (9.25)

0-3 (4)  

4  

Parotidectomy

42415, 42420, 42425  

2-4 (10.5)  

0-1 (2.75)  

18

Pharyngo-
esophagectomy

43107

0-1 (0)  

0 (0)  

0.5  

Reconstruction flaps, local  

14040, 14020  

0-2 (2.25)  

0-2 (2.25)

13

Reconstruction flaps, muscle fasciocutaneous  

15732

0-2 (2)  

0 (0.5)  

7  

Reduction facial fracture, frontal  

21343

0-2 (0.75)  

0-2 (0.25)  

2  

Reduction facial fracture, malar  

21356/ 21366  

0-2 (2.25)  

1-4 (2.75)  

7  

Reduction facial fracture, mandible  

21453, 21454/ 21470  

0-2 (0.5)  

1-5 (3.25)  

17.5  

Reduction facial fracture, maxilla LeFort  

21421

0-2 (0.5)  

1-3 (2)  

4.25

Reduction facial fracture, nasal  

21310/ 21036

0-2 (2.25)  

2-6 (4.25)  

10.5  

Reduction facial fracture, orbital  

21385

0-2 (1.5)  

1-5 (3.5)  

5  

Scar Revision  

12001/18, 13131/52  

0-2 (0)  

0-3 (1.5)  

22

Simple Mastoidectomy  

69502

0-2 (0.5)  

0-2 (2)  

8

Sinus, antrostomy  

31020

2-5 (9.75)  

1-5 (11.75)  

57.5

Sinus, ethmoid

31200

2-5 (10.5)  

1-5 (10.25)  

56

Sinus, frontal  

31276

0-3 (4)  

0-1 (1)  

13

Sinus, sphenoid  

31050

0-3 (4.75)  

0-1 (3)  

20

Sinus, frontal, osteoplastic  

31084, 31086

0-1 (1.25)  

0 (0.25)  

2.8

Skull base surgery, posterior fossa/ cochlear implant  

61590

0-2 (1)  

0 (0)  

3.8

Stapedectomy

69660

0-1 (2)  

0 (0)  

5.8

Surgical speech fistula (TEP)  

31611

0-1 (0.25)  

1-3 (1.25)  

5

Submandibular gland excision  

42440

1-3 (4)  

1-3 (4.5)  

9

Tonsillectomy

42825.52, 42825.50

0 (1.25)  

2-5 (107.5)  

Thyroidectomy

60220, 60225, 60240  

3-8 (28.25)  

4-10 (17.75)  

26.5  

Tracheotomy

31600

0 (2.25)  

10-20 (53)  

70.5

Tympanoplasty Type I  

69620/ 69631  

0-2 (4)  

0-2 (8.5)  

22

Tympanoplasty Type II-IV  

69632/3  

0 (1)  

0 (0)  

10

Tympanoplasty with Mastoidectomy  

69635/7, 69641/2  

0-2 (6)  

0 (0.5)  

15.5


TOP

  1. Use the proximity of basic science laboratories at the Westchester site to initiate research activities.

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. Improve ability to manage and maintain efficiency of team. 

    1. Meet regularly with surgical teaching staff for guidance and discussion of issues arising from the running of the team.

  3. Develop 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.
    1. Describe a variety of coping reactions that are commonly employed by patients with life-threatening illnesses. 
    2. Describe an appropriate therapeutic response for each of the common coping reactions that are employed by patients with life-threatening illnesses.
  4. Develop skill in dealing with the psychosocial dimension of head and neck oncology:
    1. Describe the ethical issues that are involved in the treatment of patients with life-threatening illnesses.
    2. Effectively communicate with patients and their families. 
  5. Develop an understanding and appreciation of the importance of networking in the professional environment and how it can facilitate optimal patient care:
    1. Discuss the rationale for networking in the professional environment.
    2. Give examples of networking
  6. Demonstrate behaviors that reflect an ongoing commitment to continuous professional development, ethical practice, sensitivity to diversity, and responsible attitudes.
  7. Use survey procedures to complete a 360-degree examination of leadership and produce an action plan with a faculty mentor to improve identified deficiencies.
  8. Enhance the habit of self-assessment to evaluate self-image and assumptions.
  9. Show evidence of intermediate and long term planning for professional development.
  10. Demonstrate the habit of recording all tasks that need to be accomplished and ensuring that they are completed in a timely manner.
  11. Have 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.
  12. Show evidence of implementation of a networking system.
  13. Show a system (card, computer, etc.) to record information about professional contacts.
  14. Demonstrate continued maintenance of a personal operative recording database.
  15. Initiate the habit of self-assessment by gaining insight into personal character and temperament and how they impact work.
  16. Develop the habit of recording all tasks that need to be accomplished and of ensuring that they are completed in a timely manner.

B. Third-Year Resident (PGY-4)

I. Knowledge Goals. The third-year resident at Westchester should acquire superior knowledge of Head and Neck Surgery, Otology/Neuro-otology, Otolaryngologic emergency care and Pediatric Otolaryngology. 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 third-year resident should:

  1. Demonstrate mastery of all cognitive skills developed in the prior years.

  2. Discuss the preoperative selection, operative and perioperative care, and avoidance and management of complications of patients at Westchester, in particular: 

    1. Airway surgery; larygoplasty, cricoid interposition graft, palatoplasty, and tracheotomy.

    2. Chronic ear surgery; mastoidectomy, typmpanomastoidectomy and ossicular reconstruction.

    3. Drainage of deep neck, parapharyngeal and retropharyngeal abscess.

    4. Endoscopy of the esophagus, larynx, sinuses and trachea (adult and pediatric).

    5. Endoscopic antrostomy, ethmoidectomy, frontal sinusotomy and sphenoidotomy.

    6. External approaches to the paranasal sinuses; Caldwel Luc, ethmoidectomy, ligation of the internal maxillary artery, osteoplastic frontal sinusotomy and trephination.

    7. Excision of congenital cysts and sinuses (branchial cleft, thyroglossal duct).

    8. Laryngeal fractures, with open reduction and internal fixation with or without stenting.

    9. Laryngeal framework surgery, vocal fold medialization by injection and airway management by artyenoidectomy/arytenoidopexy.

    10. Laryngectomy; total, horizontal, supraglottic and supracricoid.

    11. Maxillectomy; medial and total with and without orbital exeneration.

    12. Neck dissection, modified and radical.

    13. Marginal and segmental mandibular resection.

    14. Parotidectomy, resection of parapharyngeal space and submandibular gland neoplasms.

    15. Repair of CSF rhinorrhea; endoscopic and external approaches.

    16. Repair of blunt and penetrating injuries to the face and neck, both hard and soft tissue injuries.

    17. Resection of neoplasms of the upper aerodigestive tract.

    18. Resection of vascular tumors and anomalies.

    19. Reconstruction of surgical wounds using local, regional, distant and free flaps.

    20. Skull base surgery, including posterior fossa surgery.

    21. Thyroidectomy and parathyroidectomy.

    22. Transeptal hypophysectomy.

    23. Vascular surgery, repair of venous and arterial lacerations and ligation of major vessels of the head and neck.

  3. Describe the range of treatment modalities for benign and malignant disease of the head and neck. 

II. Skill Goals. The resident must demonstrate ability to manage the range of patients on the Otolaryngology Service at Westchester Medical Center, including:

  1. Supervise junior residents and coordinate nursing, social services and administration to optimize patient care.

  2. Assist faculty with supervision of the outpatient clinics, consultations, and emergency room care of patients.

  3. Develop the treatment plan for all patients undergoing medical or surgical care on this service and direct the presentation of appropriate patients to the Head and Neck Tumor Board and Combined Neurosurgical/Otolaryngology Skull Base Conference.

  4. Demonstrate competency in performing ambulatory and inpatient surgical experience consistent with programmatic and national standards for the following procedures:

Procedure CPT-95 Expected Range & (Program Average) for PGY-4, assistant Expected Range & (Program Average) for PGY-4, surgeon Average, American
Board of Otolaryn-
gology Report of Graduating Residents, surgeon

Acoustic Neuroma/ CP Angle tumor resection

61526

0-2 (4)

0 (0)

0

Branchial cleft anomaly/ Thyroglossal duct cyst/ dermoid cyst excision  

42815, 60280, 30124/ 30125, 38555, 38550

0 (1.5)

0-2 (14)

2

Bronchoscopy, diagnostic

31622, 31635, 31630

0 (0)

4-8 (22.5)

7 (panendo all CA pts)

Composite resection

41155, 41155.52

0-2 (6)

0-1 (4.5)

1

Craniofacial / Anterior skull base resection

61580.615

0-1 (6)

0-1 (0.25)

0

Direct laryngoscopy, adult

31525, 31541

0 (1.5)

5-10 (83.5)

5

Direct laryngoscopy, pediatric

31520, 31530

0 (0)

0-3 (7.5)

7

Esophagoscopy

43200, 43215

0 (1)

3-8 (49)

3

Hemilaryngectomy, vertical

31370

0 (0)

0-1 (1)

0

Hemilaryngectomy, horizontal

31367

0 (0)

0-1 (0)

0

Incision and Drainage deep neck abscess

21501

0 (1.5)

0-2 (4.5)

2

Laryngectomy, Total

31360

0 (2)

0-2 (1.5)

4

Laryngo-
pharyngectomy

31390

0(1.5)

0-1 (1)

0

Laryngoplasty/ Arytenoidectomy/ Thyroplasty

31582, 31400, 31588

0 (1)

0-2 (4.5)

1 medializations w/ Dr. Zalvan)

Maxillectomy

31225.52, 31225, 31230

0 (7.5)

0-3 (4)

0

Modified/Radical Mastoidectomy

69505, 69511

0 (0)

2-5 (4)

2

Neck dissection

38720, 38724, 38724.52

0 (23)

3-5 (19.5)

9

Oral Cavity tumor resection/ glossectomy

41112, 41120, 41130, 41140

0 (5)

2-4 (7.5)

2

Parathyroidectomy

60500

0 (5.5)

2-5 (13)

3

Parotidectomy

42415, 42420, 42425

0 (12.5)

2-6 (12.5)

2

Pharyngo-
esophagectomy

43107

0 (0)

0-1 (0)

0

Reconstruction flaps, local

14040, 14020

0 (8.5)

0-2 (9.5)

2

Reconstruction flaps, muscle fasciocutaneous

15732

0 (9)

0-1 (2.5)

4

Reduction facial fracture, frontal

21343

0 (0)

0-2 (2.5)

0

Reduction facial fracture, malar

21356/ 21366

0 (1)

1-4 (5.5)

2

Reduction facial fracture, mandible

21453, 21454/ 21470

0 (3)

2-4 (5)

3

Reduction facial fracture, maxilla LeFort

21421

0 (0.5)

1-3 (2)

1

Reduction facial fracture, nasal

21310/ 21036

0 (0)

2-5 (13.5)

3

Reduction facial fracture, orbital

21385

0 (2)

0-3 (8.5)

2

Repair, CSF Rhinorrhea

n/a

0 (n/a)

0-1 (n/a)

0

Scar Revision

12001/18, 13131/52

0 (3)

0-3 (13)

0

Simple Mastoidectomy

69502

0 (0)

0-4 (2)

1

Sinus, antrostomy

31020

0 (6)

2-6 (28.5)

6

Sinus, ethmoid

31200

0 (7)

2-6 (23.5)

6

Sinus, frontal

31276

0 (3.5)

0-2 (1)

1

Sinus, sphenoid

31050

0 (4)

1-3 (9)

2

Sinus, frontal, osteoplastic

31084, 31086

0 (2.5)

0-1 (5)

0

Skull base surgery, posterior fossa/ cochlear implant

61590

0-2 (4)

0-1 (1.5)

0

Stapedectomy

69660

0-2 (3)

0-2 (1)

Surgical speech fistula (TEP)

31611

0 (1)

1-3 (3)

1  

Submandibular gland excision

42440

0 (2)

0-2 (9)

Thyroidectomy

60220, 60225, 60240

0 (28)

4-8 (51.5)

8

Tracheotomy

31600

0 (3.5)

3-8 (61.5)

5

Tympanoplasty Type I

69620/ 69631

0 (2)

2-5 (8)

0

Tympanoplasty Type II-IV

69632/3 

0 (1)

0-2 (1)

0

Tympanoplasty with Mastoidectomy

69635/7, 69641/2  

0 (2)

3-9 (6)

0


 
Pediatric Experience with Dr. Deserres

Procedure

Expected Range

Period 1/1/06 - 4/1/06

Laryngotracheal Reconstruction

1-4 (Surgeon)

2  

Pharyngoplasty

1-5 (Surgeon)

2

Pediatric FESS

1-5 (Surgeon) 

Pediatric Brochoscopy

3-7 (Surgeon)

8

Pediatric Tracheostomy

1-5 (Surgeon)

 

Facial Plastic Experience with Dr. Honrado

Procedure

Expected Range

Period 1/1/06 - 4/1/06

Rhinoplasty

1-4 (Surgeon)

Local and Rotational Flaps

1-4 (Surgeon)

2

Pectoralis Flasps

1-4 (Surgeon) 

 

 

TOP

  1. Use the proximity of basic science laboratories at the Westchester site to initiate research activities.

III. Attitude Goals.  See A.III.

 

Home > Educational Programs > Residency and Fellowship Programs > Otolaryngology > GOALS & OBJECTIVES