* PGY 1 shall have a minimum of (5) months on at least 3 of the following service: General Surgery, Vascular Surgery, Pediatric Surgery, Plastic Suregery and/or Surgical Oncology and a two (2) months roation each on Emergency Medicine, Crticial Care , Anesthesia, and Nuerology.
** NYEE 3rd rotation is clinical education in Laryngology, Occuloplastics, Pathology, Pediatric Head and Neck Surgery and Radiology: AKA, Academic Rotation
Prior to July 1996, residents were required to complete two years of preliminary training in General Surgery. This has now been replaced by a transitional year that is considered their first year of otolaryngology training. In 2004, the Residency Review Committee in Otolaryngology mandated the Program Director for each Otolaryngology residency insure that residents receive a balanced and appropriate surgical experience in this preliminary year. This curriculum must now include general surgery, critical care, neurosurgery and otolaryngology. Further, the Program Director must meet with the preliminary residents twice a year. This mandate is met through preliminary residents rotating one month at the NYEE, and through close cooperation between the Directors of Surgery and Otolaryngology. The program considers that the education of otolaryngology residents begins during the general surgery training. Residents are instructed to begin the American Academy of Otolaryngology Home Study Course and to complete general readings in otolaryngology while on Surgery.
Residents are required to take the annual surgery examination. The Director of the General Surgical Training Program (Dr. Jeffrey Leitman at Mount Sinai Beth Israel and Dr. Christopher Mills) participates in the ongoing evaluation of preliminary residents' surgical skills, patient care, moral character, and overall competence. The resident's educational experience is discussed and any problems encountered during the general surgical year are reviewed so that corrective action can be taken in a timely manner.
The four residents in the second year of otolaryngology training are at New York Eye and Ear Infirmary of Mount Sinai (NYEE) for nine months where they work under the close supervision of the attending staff and senior residents. Clinical experience at New York Eye and Ear Infirmary is one of the primary responsibilities and educational benefits of the second-year program. Residents rotate three months each on the Head and Neck, Otology/Neurotology, and Facial Plastic Services. For the remaining three months, residents are at Mount Sinai Beth Israel.
Upon arrival at New York Eye and Ear Infirmary, each resident is provided with a copy of the department's current reading list along with supplemental suggestions for each three-month block within the four-year program. The department's educational syllabus is given to incoming residents and reviewed with them periodically. Specific Goals and Objectives for each training site and year are available through the NYEE website. All incoming residents participate in a series of lectures and practical sessions that introduce them to clinical otolaryngology. The faculty and senior residents give this course. It summarizes the clinical problems that the new resident is most likely to encounter while performing regular hospital duties.
The educational emphasis during the second year exposes the new resident to the entire field of otolaryngology. The second-year resident's clinical responsibilities are to deliver ward and clinic care, and to perform selected surgical procedures under direct supervision. The resident assists in performing major surgical procedures and is guided in executing those portions of the operations that are appropriate to his or her level of training.
Second-year residents have a broad surgical experience due to the large number of operations performed annually. Over subsequent years, the surgical experienced has tended to remain constant, but the intensity of cases have increased reflecting the growing surgical case load at both the NYEE, and Mount Sinai Beth Israel. The operations most commonly performed by the second-year residents are tonsillectomy, adenoidectomy, myringotomy with insertion of tympanostomy tube, excision of skin lesions, closed reduction of nasal fracture, direct laryngoscopy, bronchoscopy, esophagoscopy, submandibular gland excision, and nasal septal reconstruction. In addition, second-year residents participate in most major otologic, head and neck, thyroid, and oncologic procedures. They are the first surgeon for tympanoplasties and assist on mastoidectomies. In order to assure that each resident receives a comparable experience, the Director of Residency Training and the Department Chair monitor the distribution of cases among the residents.
Second-year residents participate in ward rounds held on each service. The format varies from service to service. However, the general format is for daily evaluation of each patient on the service by the Chief Resident and attending in charge of the patient. The second-year resident presents each patient and the attending leads a Socratic-type discussion with extensive questioning of the residents about the evaluation and management of the patients. Suggestions for further reading are generally provided and residents are accountable by written examination.
During the three-month rotation on the head and neck service, weekly participation is required in the speech laboratory to conduct quantitative aerodynamic, kinematic, and acoustic evaluations of speech and voice, and to perform endoscopy and videostroboscopy. Selected patients are discussed at the monthly voice conference. A separate esophagoscopy clinic is held every Thursday morning to train junior residents in flexible esophagoscopy. Residents are also required to review their surgical pathologic specimens with the department's pathologist, Dr. Steven McCormick. The resident presents pre- and post- operative oncology cases at the combined Tumor Board. Selected topics, as they relate to the head and neck service, are presented during the Basic and Clinical Science Courses.
During the three-month rotation on the otology service, Dr. Linstrom and other attendings give weekly lectures on pertinent topics related to the clinical diagnosis and management of disorders of hearing, balance and the facial nerve. Selected topics, as they relate to otology, are presented during the Basic and Clinical Science Courses and in Temporal Bone Laboratory and Histopathology/Molecular Biology Course.
Exposure to audiology and speech pathology is provided through didactic lectures given throughout the year. Residents are required to attend an audiology practicum to gain hands-on knowledge of the mechanics of pure tone and speech audiometry, impedance audiometry, ENOG testing, brainstem response audiometry, electronystagmography, platform posturography, and rotation chair testing. The second year resident presents selected cases for discussion at the biweekly Audiology Conference. Combined Mount Sinai Beth Israel and NYEE Cochlear Implantation and Vestibular Conferences are held monthly. The residents and faculty present the clinical history, results of relevant testing (see above), and the pre- and post-operative status of cochlear implant patients. Additionally, the resident receives thorough training in the indications for amplification and common problems with hearing aids. A similar educational program is employed for speech pathology using the voice laboratory as the clinical environment and the voice conference as the teaching environment.
The second-year resident receives training in otolaryngologic allergy and immunology during the Basic Science Course and during the clinic sessions devoted to allergy. The residents gain a first hand knowledge of the treatment of allergic problems through their attendance at the weekly Allergy Clinic. The second-year resident receives instruction in both basic and clinical endocrinology during the Basic Science Course as well as during the rotation on the Head and Neck Service.
At the completion of each clinical rotation and for the subsequent entire period of training, each resident is required to evaluate anonymously each faculty member, their peers and the quality of each rotation using a web-based in-house developed system which conforms the Accreditation Council for Graduate Medical Education requirements for the six clinical competences (see ACGME.org). Residents anonymously annually review the entire program. Parameters evaluated include: teaching/mentoring, patient exposure, variety and complexity of surgical experience, environment, and overall satisfaction. Faculty members formally evaluate each resident semiannually to assess their clinical skills, patient and professional interactions, patient care, educational objectives, and research activities. These evaluations are discussed with the resident and any problems are resolved.
The third year of residency training is divided between New York Eye and Ear Infirmary Head and Neck oncologic surgery service (three months), Mount Sinai Beth Israel (three months), and the Westchester Medical Center (two three-month rotations). Further discussion of these rotations is included under the respective medical centers and detailed in Goals and Objectives. These rotations afford the resident the opportunity to broaden their knowledge, experience, and clinical skills through exposure to different clinical situations in hospitals of varying size and character, and by working closely with a variety of otolaryngologists at these institutions.
The third-year resident builds upon the knowledge and experience gained in the first year and adds the development of analytical and problem solving skills. The resident's primary patient care responsibility is to deliver and direct clinical and ward care, particularly for the critically ill patient and more complex cases. The resident assumes increased responsibility for patient care with attending surgeons providing support. Surgical responsibilities for this year include performing (as primary surgeon) more complex cases than those performed in the second year of otolaryngology (for example, partial glossectomy, endoscopic ethmoidectomy, substernal thyroidectomy, mastoidectomy, tympanoplasty, rhinoplasty, excision of facial lesions, and local flaps). Expertise is increased in those procedures performed as a second-year resident. The third-year resident first assists major cases, supervises junior residents performing second-year cases, and performs a selected group of major cases as primary surgeon under attending supervision.
Further training in allergy, immunology, endocrinology, neurology, pathology and radiation oncology occurs both during the Basic Science Course and clinical rotations. Although the third-year resident does not formerly rotate through otology and neurotology at the NYEE, he or she receives significant exposure in this subspecialty, including audiology, at Westchester Medical Center.
During the third year of otolaryngology, the resident participates in core conferences conducted at New York Eye and Ear Infirmary. The resident also completes a second temporal bone dissection course under the direction of Dr. Christopher Linstrom and staff which is conducted every two weeks except during the summer. The principles of microsurgical dissection taught in the first-year course are reviewed and new skills of tympanoplasty, mastoidectomy, ossiculoplasty and facial nerve dissection are taught.
The third-year resident is required to participate actively in ongoing research as a junior contributor and to continue to work on research projects begun in the second year. The third-year resident must prepare at least one clinical and/or basic science research project for presentation to his fellow residents and the attending staff. This project is expected to be more sophisticated than the first year's project and is evaluated critically with the intent that it is prepared for presentation at a national or regional conference and/or for publication in a refereed journal.
In addition, the third-year resident continues the preparatory work which he or she began as a first-year resident for the three-month block of research time to be completed in the third year. The success of this staged approach to research training is reflected in the fact that, over the past five years, our residents have won regional and national ( American Academy of Otolaryngology, American Laryngologic Association and American Academy of Facial Plastic & Reconstructive Surgery) research competitions and patents for commercialization of their research findings.
The fourth-year resident is at Westchester Medical Center (three months), New York Eye and Ear Infirmary (three months) and the Academic Rotation (three months). The remaining three-month period is set aside for the research rotation. At New York Eye and Ear Infirmary, the fourth-year resident assumes a more supervisory role in the clinics and in the Otology Service. Completing the fourth-year course in the temporal bone laboratory further enhances the resident's surgical skills. At the fourth-year level, the resident is expected to perform these otologic procedures: tympanoplasty, tympanoplasty with mastoidectomy, basic ossicular chain reconstruction and stapedotomy. The resident assists in other otologic procedures. The fourth-year resident is the service chief at Westchester Medical Center. He or she performs major and complex surgical procedures, such as composite resection, radical neck dissection, parathyroidectomy, pharyngolaryngectomy, myocutaneous and free flaps, and all major otologic procedures. He or she first-assists on major neurotologic and base-of-skull procedures. The Academic Rotation is divided between Mount Sinai Beth Israel and New York Eye and Ear Infirmary, and consist of assigned rotations with Dr. Robert Della Rocca on Oculoplastic and Orbital Surgery, Dr. Roy Holliday on Head and Neck Radiology, Dr. Bruce Wenig on Surgical Pathology, Drs. Steven Schaefer or Michael Pitman on Laryngology and Dr. Milton Waner on Pediatric Head and Neck Surgery.
Three chief residents are assigned to New York Eye and Ear Infirmary with responsibility for the Head and Neck Service, the Otology Service, and the Facial Plastic and Reconstructive Service, respectively. The remaining three months are on the Head & Neck Service at Mount Sinai Beth Israel (see Goals and Objectives for specific cognitive and skill goals).
During the fifth year, residents assume greater supervisory responsibility for the clinic, ward, and operating room. The resident's primary surgical responsibility is to refine surgical technique and to perform major surgical procedures with varying levels of faculty assistance. Each chief resident directs the more junior residents on the respective services and reports to the faculty members in charge of the service. The chief residents meet frequently with the Department Chair and the Director of Residency Training to discuss their progress as well as to receive advice on administrative matters. Each year, the junior residents evaluate the performance of the chief residents with respect to their mentoring abilities and their stature as a role model. The most outstanding chief resident, based on these evaluations, is recognized annually.
The chief resident on the Head and Neck Service at both the NYEE and Mount Sinai Beth Israel perform all major head and neck procedures under the direct supervision of the attending staff. He or she may delegate certain of those cases to junior residents. He or she also provides direct supervision of the junior residents with the support of the attending staff. He or she receives training in all oncologic procedures, salivary gland and thyroid surgery, major flap reconstructive procedures, anterior skull base procedures, and management of maxillofacial trauma. The chief is trained in both standard and endoscopic treatment of paranasal sinus disease.
The chief Otology resident will within a three-month rotation, ordinarily perform several times the American Board of Otolaryngology operative experience for graduating residents in such areas as stapedectomy (approximately half with the argon laser), tympanoplasties, with/without mastoidectomy, and will assist in more advanced cases, such as cochlear implantations, surgery for Meniere's disease, facial nerve decompression and repair and surgery to correct congenital aural atresia. He or she supervises junior residents on the Otology Service in the performance of selected operative procedures. The chief resident participates in the pre-operative diagnosis and evaluation of retrocochlear and skull base cases. Skull base cases are scheduled at Beth Israel. Residents are joined in these cases by the resident in neurosurgery. These cases include acoustic neuroma, glomus tumors, meningiomas, and sinus neoplasms.
The chief resident on the Facial Plastic and Reconstructive Service performs all major facial plastic and reconstructive procedures. The chief resident will, during a three-month rotation, perform approximately 30 to 50 rhinoplasties, four face and brow lifts, 15 maxillofacial procedures, and 4 reconstructions for congenital facial anomalies. The chief resident assists on cleft lip and palate repair, major orthognathic cases, maxillofacial trauma, and repair of orbital fractures. Prior to 1997, the chief resident on the facial plastic service also served as the administrative chief resident. This resident met on a periodic basis with all other residents to identify such issues as working conditions, the schedule, and the overall educational program to be brought to the attention of the appropriate administrative staff. Since 1997, one chief resident is selected for the year to be administrative chief resident.
The chief residency year serves not only to give the residents broad and deep experience in operative cases, but also to develop their administrative abilities in a close working relationship with the Department Chair. It is expected that these experiences will prepare the graduating residents to assume positions in private and academic departments throughout the country. It should be noted that the chief residents are involved in various departmental and institutional committees relating to such issues as hospital management and the changing trends of health care delivery systems. As practiced in all years of training and all sites, chief resident are evaluate using the six clinical competences formulated by the ACGME.