PGY-1

As of July 1, 2016, the ACGME mandated that all Otolaryngology interns have six months of otolaryngology training combined with six months of non-otolaryngology electives. Careful thought was given to both which subspecialty rotations would optimize intern education and how to maximize learning opportunities in the 6 ORL months. The six elective rotations chosen for our interns – trauma, ICU, general surgery, anesthesia, neurosurgical ICU, and plastics - are based on the rotation quality as well as what best compliments the training we already offer. Nine months are on our Moses campus, and three are at Jacobi Medical Center (trauma, ICU, and general surgery).

Interns take no overnight call but the 2 ORL interns alternate a weekend during which they shadow the PGY2-3s on call for one day, either Saturday or Sunday, from 8 am-5 pm.

Dr. Bradley Schiff directs the intern year experience, and Dr. Christina Fang directs our department’s mentoring program.

Otolaryngology Bootcamp

The Otolaryngology Bootcamp takes place in July and August at the Einstein Simulation Center, typically on 4 Fridays, specific dates and times TBD, under the direction of Drs Gibber and Yang. All PGY1 residents will be excused from their clinical duties in order to attend. PGY1 residents not assigned to ORL will be assigned to NSICU, plastics, or anesthesia during July and August. Those services have agreed to allow ORL PGY1s to be excused in order to attend Bootcamp.

PGY-1 Goals and Objectives

Assignment

Two PGY1 residents will be on Moses West campus simultaneously, and they will rotate responsibilities equally between inpatient duties for one and operating room for the other, changing every two weeks. Basic inpatient care responsibilities include rounding, writing progress notes, appropriate orders, reviewing and acting on laboratory and radiographic results, monitoring progress with postoperative inpatient rehabilitation, wound care, discharge instructions, and obtaining appropriate consultation as required. All questions must be escalated to more senior personnel. The inpatient resident will also be the first responder to inpatient and emergency room consults and will perform most elective bedside tracheotomies. These duties will take priority over clinic time. However, at least ½ of a session per week of the clinic is mandatory, and more are encouraged. These clinic sessions should vary between specialties so that by the end of the rotation, each intern has had multiple office sessions in each specialty. Emphasis will be on fundamental patient care in the hospital setting as a foundation for more sophisticated otolaryngology subspecialty care later in residency.

The operating intern will be assigned to either pediatrics or head and neck cases at the discretion of the H&N chief resident in consultation with the peds chief resident. Typical cases include learning tracheotomy, T&A, and BMT or assisting with open head and neck procedures with an emphasis on wound closure.

Goals

1. Acquire general medical knowledge in the care of patients with complex medical problems, with an emphasis on inpatients
2. Understand basic surgical techniques, in particular ergonomics and proper handling of instruments and soft tissue, and
3. Gain fluency with fundamental otolaryngology in the outpatient clinic, hospital wards, and operating room.
4. Build a framework for life-long learning.

Objectives

Patient care

1. Show mastery of general medical H&P skills taught in medical school, including risk assessment evaluation.
2. Be able to obtain, review, and concisely summarize relevant medical reports.
3. Attain fundamentals for performing a comprehensive head and neck history and physical examination
4. Perform a thorough peri-operative work up, write pre-operative orders, and involve other specialties as needed.
5. Be able to recognize worrisome medical conditions and the context of abnormal results.
6. Develop an understanding of fluid, electrolyte, and acid-base balance, and become proficient in fluid resuscitation and management, properly adjusting for co-morbid conditions.
7. Work up and treat fever and surgical infection, understanding the pathophysiology, differential diagnosis, and treatment options.
8. Understand how to use specific otolaryngology office equipment, including otomicroscope, headlight, nasal speculum, laryngeal mirror, and rigid and flexible endoscopy.
9. Monitor, observe, manage, and maintain the stability of 1+ patients at different stages of work-up or post-op recovery, including fundamental lab tests and radiological studies.
10. Establish the acuity level of otolaryngology consults in the ER and establish priorities to begin management.
11. Learn to perform rudimentary procedures, including controlling epistaxis, draining peritonsillar abscess, removing cerumen, tracheotomy, tonsillectomy, adenoidectomy, myringotomy with tube, and frenulectomy.
12. Close skin incisions with proper tissue handling technique and knot tying.
13. Be able to set up for pediatric rigid bronchoscopy.
14. Understand proper patient positioning, preparation, and draping
15. Learn to suction, retract, expose, anticipate and direct an endoscope with camera.

Medical Knowledge

1. Recognize and initiate treatment for an acute anaphylactic reaction.
2. Know the differential and evaluation for common otolaryngology presentations such as nasal congestion, hearing loss, sore throat, hoarseness, and neck mass.
3. Be familiar with AAO-HNS Clinical Practice Guidelines.
4. Evaluate inpatient and outpatient consults with a proper assessment and a preliminary plan.
5. Understand perioperative care protocols.
6. Know the names of common surgical instruments and sutures.
7. Develop comfort with basic laboratory tests and x-rays, including indications and abnormalities.
8. Understanding fluid, electrolyte, and acid-base balance, and fluid resuscitation and management, properly adjusting for co-morbid conditions.
9. Be able to work up and treat fever and surgical infection, understanding the pathophysiology, differential diagnosis, and treatment options.

Professionalism

1. Demonstrate awareness of proper dress and hygiene as well as conformity with expected hospital attire in and out of the operating room.
2. Be available by phone or pager and punctual for all responsibilities
3. Understand existing resources to promote both mental and physical wellness
4. Appropriately obtain informed consent.
5. Understand and respect advanced directives.
6. Show respect, compassion, and integrity towards the needs of patients and their families.
7. Demonstrate ethical principles pertaining to patient confidentiality issues.
8. Maintain sensitivity to patients and fellow health care professionals' culture, age, gender, and disability.

Practice-based learning

1. Read about clinical problems as you encounter them.
2. Prepare for cases by reading about pathophysiology/surgical technique
3. Develop a 5-year study plan, including time to be committed to learning on a weekly basis. Become familiar with leading ORL textbooks.
4. Enroll in the home study course
5. Comprehend what online resources exist for learning, including AcademyU
6. Review research opportunities and begin contemplation of research interests.
7. Polish time-management skills
8. Prepare for and attend ORL didactic program from 700-1130am every Friday morning.
9. Gain preliminary exposure to the financial aspects of surgical practice.
10. Evaluate your care patterns and those of others. Avoid accepting care paradigms without evidence and proof.
11. Build appreciation that you will advance clinical care by questioning and investigating everything as you assimilate new and emerging methodologies.
12. Learn about departmental research projects
13. Learn to use electronic resources, including:
    1. Computerized literature search engines (Pubmed, Medline, etc.)
    2. Access Gottesmann Library remotely
    3. Access New Innovations
    4. Access NIH, NCI, Cochrane database
    5. Explore AcademyU
14. Improve familiarity with biostatistics for the interpretation of medical literature
15. Learn principles and limitations of evidence-based medicine methodology

System-based practice

1. Perform a thorough peri-operative workup, write pre-operative orders, and involve other specialties as needed.
2. Develop fluency in hospital electronic medical records
3. Understand patient instructions for common otolaryngology interventions
4. Learn how to log cases on the ACGME website
5. Be able to recognize worrisome patient conditions and escalate as needed.
6. Collaborate with physicians and other professionals across specialties to evaluate and treat patients, arrange appropriate placement and transfer if necessary, formulate a follow-up plan, and communicate effectively with patients, family, and involved health care members.
7. Learn how to institute an evidence-based practice

Interpersonal and Communication Skills

1. Summarize clinical material in a relevant, concise, and comprehensive way.
2. Share critical information with other residents and faculty.
3. Clearly, accurately, and respectfully communicate with nurses and other hospital employees.
4. Establish therapeutic and ethically sound relationships with patients and their families.
5. Educate patients and families regarding interventions, outcomes, test results, and implications.
6. Use the language banks and Interpreters to communicate with patients and families in their native language.
7. Speak with patients in non-technical language, respecting their cultural and educational backgrounds.
8. Choose a faculty mentor
9. Maintain an approachable demeanor
10. Express needs and concerns without offending.
11. Hear the concerns of others, and effectively use listening skills.
12. Give and receive feedback in the spirit of just culture. Participate in QI conference.
13. Demonstrate self-awareness
14. Know about available backup resources and have a low threshold for requesting help.
15. Teach ancillary staff and medical students
16. Learn how to work within the framework of a team

Goals and Objectives for the six non-ORL rotations during the intern year are available in the resident handbook.