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To browse Otolaryngology Resident Training Program
Breakdown, select a year:
Preliminary | First year |
Second year | Third year | Fourth year
| Block Diagram
Preliminary
Year(s) of General Surgery
Prior to July 1996, residents were required
to complete two years of preliminary training in General Surgery.
They are now required to complete one year of General Surgery at either St. Vincent
’s Medical
Center or Beth Israel
Medical
Center. 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 Eye and Ear, 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. Anthony Antonacci at Beth Israel Medical Center and Dr. Marc Wallack) 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.
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First Year of
Residency
The four residents in the first year of
otolaryngology training are at the New York Eye and Ear Infirmary for nine
months where they work under the close supervision of the attending staff
and senior residents. Clinical experience at the New York Eye and Ear
Infirmary is one of the primary responsibilities and educational benefits
of the first-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
Beth
Israel
Medical
Center
.
Upon arrival at The 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 Eye and Ear 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 first
year exposes the new resident to the entire field of otolaryngology. The
first-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.
First-year residents have a broad surgical
experience due to the large number of operations performed annually. For
example, each of the four residents who completed his/her first year on
June 30, 2000
, participated in an average of 420 surgical cases including approximately
310 patient operations as surgeon and 110 operations as assistant. 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 Eye and Ear, and Beth Israel. The operations most
commonly performed by the first-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, first-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.
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First-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
first-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 first year
resident presents selected cases for discussion at the biweekly Audiology
Conference. Combined Beth Israel and Eye and Ear 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 first-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 first-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.
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Second Year of Residency
The second year of residency training is
divided between the New York Eye and Ear Infirmary Head and Neck oncologic
surgery service (three months), St. Vincent's Medical Center (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 second-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 first year of otolaryngology (for example, partial
glossectomy, endoscopic ethmoidectomy, substernal thyroidectomy,
mastoidectomy, tympanoplasty, rhinoplasty, and excision of facial
lesions). Expertise is increased in those procedures performed as a
first-year resident. The second-year resident first assists major cases,
supervises junior residents performing first-year cases, and performs a
selected group of major cases as primary surgeon under attending
supervision.
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raining in allergy, immunology,
endocrinology and neurology occurs both during the Basic Science Course
and clinical rotations. Although the second-year resident does not
formerly rotate through otology and neurotology at the NYEEI, he or she
receives significant exposure in this subspecialty, including audiology,
at
Westchester
Medical
Center
.
During the second year of otolaryngology,
the resident participates in core conferences conducted at The New York Eye and Ear Infirmary.
The resident also completes a second temporal bone dissection course under
the direction of Dr. Joseph Arigo 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 second-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 first year. The
second-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 second-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.
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Third
Year of Residency
The third-year resident is at
Westchester
Medical
Center
(three months), St. Vincent
's Medical
Center
(three months) and the Academic Rotation (three months). The remaining
three-month period is set aside for the research rotation. At The New York Eye and Ear Infirmary, the third-year resident assumes a more supervisory role in the
clinics and in the Otology Service. Completing the third-year course in
the temporal bone laboratory further enhances the resident's surgical
skills. At the third-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 third-year resident is the service chief
at
Westchester, and
St. Vincent
’s 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 Beth
Israel and The 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 Lucian Sulica on Laryngology and Dr. Milton Waner on
Pediatric Head and Neck Surgery.
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Fourth Year of Residency
Three chief residents are assigned to the
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
Beth
Israel
Medical
Center
(see Goals and Objectives
for specific cognitive and skill goals).
During the fourth 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 Eye and Ear and 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.
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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
St. Vincent's Hospital and Beth Israel Medical Center. 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.
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Block
Diagram
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of the
Otolaryngology Resident Training Program.
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