Resources and Facilities at New York Eye and Ear Infirmary of Mount Sinai

Resource / Facility Yes No Comment

Number of beds in hospital

 

 

103

Outpatient Otolaryngology Clinic

x

 

19 examination/treatment rooms

Dedicated Support Personnel

x

 

 

Departmental Offices On Site

x

 

approx. 10,000 sq ft

Operating Rooms

x

 

16 rooms

Library

x

 

24-hour access

On-Call Rooms

x

 

1 room

Speech Pathologists/Audiologists

x

 

 

Head & Neck Pathology

x

 

 

Dedicated EM, tissue culture, & molecular laboratory

x

 

services on site

Radiology / Neuroradiology

x

 

5/7

Board Certified Neuroradiologist

x

 

1

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Outpatient Clinics

The General and Specialty Clinics in the Department of Otolaryngology - Head and Neck Surgery at New York Eye and Ear Infirmary of Mount Sinai (NYEE) served 44,239 patients from January 1, 2000 through December 31, 2000. There were 21,584 visits to the General Clinic and the following visits to specialty clinics: Head and Neck: 1,086; Otology: 1,552; Facial Plastic and Reconstructive: 576; Allergy: 1,483; Pediatrics: 5,207; Audiology: 5,726; Speech Pathology: 1,920; and the remainder in miscellaneous specialty clinics. Further, residents are involved in the care of an additional 18,000 patients seen in the full time academic faculty practice, and may participate in the care of an additional 6,274 Audiology patients and 3,080 Speech Pathology patients.

General clinics run five afternoons a week and Saturday mornings at the New York Eye and Ear Infirmary. The General Clinic serves as a triage site for the specialty clinics. Specialty clinics are arranged on designated mornings: Head and Neck on Monday mornings; Facial Plastic and Reconstructive Surgery on Tuesday mornings; Otology/Neurotology on Tuesday and Thursday mornings; and Allergy on Wednesday and Friday mornings. Allergy clinic has special faculty assigned to them including Dr. Michael Teitel.

Each clinic is run as an academic experience and the attending staff monitors residents' performance. Individual problems are discussed as they arise. Residents are credentialed for clinic procedures according to the New York Health Department regulations. Residents are expected to examine patients, obtain accurate and complete clinical (history, signs, & symptoms) and laboratory data, formulate a comprehensive plan for evaluation and treatment of the patient and present that plan to the attending physician. The patient load is borne partially by physician assistants who are supervised by residents and attending physicians through reviews of patient histories and physical examinations.

Residents are expected to recall facts relative to overall patient care and to interpret data and tests. They are required to analyze and interpret appropriate data relative to individual patients to establish a diagnosis and treatment plan. At least one member of the full time or part time staff provides supervision in all clinics at all times.

Residents also participate in the educational process by providing guidance and instruction to more junior residents, medical students (including participation in a Robert Wood Johnson grant to train general physicians), and physician assistants. In this role, residents have access to the advice and help of the faculty and attending staff.

Residents are expected to perform minor surgical procedures in the clinic (such as myringotomy, flexible nasopharyngolaryngoscopy, otomicroscopy, incision and drainage). Direct attending supervision is provided at all times until competence to work independently is assured and certified. Attending physicians remain provide onsite supervision. The faculty member monitors resident procedures and demonstrates proper technique.

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Inpatients

Residents are expected to interpret physical signs and laboratory data accurately on all inpatients and to recall necessary facts relative to the patient. They are expected to analyze and interpret appropriate data to establish the diagnosis and formulate a treatment plan. Residents are expected to perform all minor procedures (for example, lumbar puncture) and to conduct patient histories and physical examinations. Chart documentation of all activities is emphasized and the need for clarity is reinforced.

Residents are closely monitored by the faculty for all inpatient care. Faculty review patient records and follow the hospital course of all inpatients. Daily rounds are carried out in the morning and evening.

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Operating Room

Residents are expected to demonstrate appropriate pre-operative planning and a complete and current knowledge of the patient. Residents on the individual services are expected to recall facts relating to the patient's disease process and to be familiar with the anatomy of the planned surgical procedure. Surgical approaches must be understood, and the resident should be able to defend the particular approach chosen. Alternative approaches must be understood and outlined by the residents. Adherence to proper, skillfull, and safe surgical technique is required. Resident participation in surgical procedures is determined by their level of training and ability, and not by whether or not the patient is private or teaching.

Close working relationships with operating room personnel are encouraged. Residents are expected to be in constant attendance of the patients until the patient is in the Recovery Room. Progress relative to these objectives is evaluated through close faculty review and a monthly Morbidity and Mortality Conference. Further monitoring is performed by focused quality assurance reviews and, more recently, by outcome studies and national resident operative statistics made available through the American Board of Otolaryngology(see figure comparing national average)of resident operative procedures to NYEE resident procedures).

The chief resident of the respective service assigns residents to particular cases. Residents are expected to assess their own surgical results in consultation with faculty. Senior residents and faculty closely supervise appropriate intra- and post-operative care. This process of progressive supervision permits each resident within each year to establish his or her level of autonomy and clinical judgment in the operating room (or the clinic) while being closely monitored by the faculty and peers.

For example, a first year resident begins performing a tonsillectomy with a faculty member, and after more than twenty tonsillectomies and depending on the skill of the resident, the faculty member may elect to have a senior resident assist the junior resident with the faculty member present for the critical aspects of the surgery. At the fourth year of training, the resident would be allowed to begin a surgical procedure, such as a thyroidectomy, and the faculty would be present for the critical phases of the procedure. However, New York State law and the program policies, require the faculty to be present for all resident surgeries.

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Research

Residents are expected to participate in ongoing and self-initiated research and must develop individual clinical and/or basic research projects on an annual basis. Ongoing investigations within departmental laboratories provide four broad areas of research: Facial Plastic and Reconstructive Surgery, Molecular Biology, Hearing and Related Disorders, and Voice and Vocal Tract. Self-initiated projects are developed in close consultation with at least one faculty advisor and are reviewed periodically by faculty advisor(s) and at the monthly research conference.

All residents are required to attend the monthly departmental research conference. Monthly conferences provide opportunities for residents to present informal progress reports and to raise questions to faculty members concerning their research projects.

The first-year resident is required to take an active interest in ongoing clinical research projects, to join as a junior author in the preparation of publications, and to originate his or her own case reports and clinical studies for publication. All residents in the program are required to prepare projects for presentation at departmental conferences. Residents learn to develop appropriate questions relating to clinical and basic research areas and to design methodologies to answer these questions.

Each resident chooses a preceptor from among the faculty to guide him or her in designing, conducting, and presenting research performed during the dedicated, three-month research rotation in the third year. During the first year, the resident must identify a faculty research mentor and begin to formulate a research question. Brief research proposals are submitted for faculty review and approval at the end of the first year of otolaryngology. During the second year, the resident develops the design for the study to be conducted during the research rotation. The resident prepares an oral presentation of the project early in the second year and submits a detailed research proposal, written in National Institutes of Health RO1 format, at that time.

The research rotation occurs during the third year of otolaryngology. As many of these projects are complex, much of the preliminary work is performed prior to the research rotation. Final research reports are presented at resident conferences for critique and review with emphasis on preparation for national presentation and/or publication. Most residents are involved in more than one project as evidenced by a number of publications per resident of 1 to 26 in the past five years. Each resident may attend selected extramural conferences and courses in order to present research papers.

For more information

Please visit the Otolaryngology Resident Research section >>

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Clinical Rounds & Conferences

All residents participate in teaching rounds and conferences held on weekly, biweekly, monthly, quarterly, and annual bases.

Weekly teaching rounds are: Head & Neck, SIPac Review (Mondays), Pediatric Otolaryngology (Tuesdays), Otology / Neuro-Otology (Thursdays). Weekly conferences are: Clinical Science (Wednesday), Radiology (Thursdays). Biweekly teaching activities include the Journal Club, Basic Science Course at the New York Academy of Otolaryngology, and Tumor Board. Monthly teaching activities are: Department Grand Rounds (including: Visiting Professor lectures, Mortality & Morbidity, CPC, Radiology, and resident research presentations) and Research Conference.

Separate voice and clinical audiology conferences, skull base conference, and the Temporal Bone Dissection Course are held monthly. Quarterly activities include the American Academy of Otolaryngology (AAO) Home Study Course. Annual activities include the AAO In-service Examination.

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