PGY-3 Ambulatory Care Elective

Ambulatory Care Elective

This rotation lasts for three months for all our PGY3 residents.

Goals:

• Fortify weaknesses in residency training
• Address deficiencies in office-based training
• Active, not passive engagement in all experiences
• Prescribe some experiences as mandatory learning
• Allow the individual learner to customize the majority of experience to his/her needs
• Provide protection against most residency demands to foster independent study and wellness

Policy:

• PGY3s must submit a plan every three months to the admin chief resident one month in advance (by May 15 for July 2020 rotation)
• If CR approves, then forward to PD for final approval
• We will design learning objectives for each experience
• An individual teacher must be in charge of quality control for each experience (i.e., a specific audiologist, not "audiology")
• The resident may be excused from Friday didactics once/mo to be with Dr. Tan but should watch GR recording within 72 hours
• The resident will be exempt from call or cross-coverage
• The resident may request (not be asked) Chair permission to cover an uncovered key index or extremely high value OR case
• One week of vacation every three months
• Up to 1 week of global health without using vacation, assuming global health is at least a 40-hour work week.
• Experience will evolve with time and the addition of more faculty and sites.

Breakdown of Rotation Schedule

1. Facial Plastics: Weekly (rotating attendings every week)
   1. Dr. Howard Stupak
   2. Dr. Konstantin Vasyukevich
   3. Dr. Andrew Jacono or Dr. Shawn Alemi
2. Laryngology: Weekly
   1. Dr. Melin Tan-Geller
      1. Once a week, in-office rotation
      2. One Friday OR day per month
3. General Private ENT: Weekly
   1. Dr. John Naughton
      1. Wednesday OR (weekly) - ½ day coverage
      2. Once a week, in-office rotation
4. Montefiore Sub-specialty clinics @ Hutch
   1. Dr. Dinces’ surgical otology clinic - once a month (usually Thursday?)
   2. Combined Allergy & Rhinology clinic - once a month (Tuesday or Friday)
   3. Combined Skull Base clinic - once a month
5. Individual-Picked Clinics: 3-4 x half days/month
   1. Otology w/ Moskowitz or Dinces
   2. Rhinology w/ Akbar
   3. Sleep w/ Park
6. Speech-Language Pathology: 2x/month
   1. Head and Neck
   2. Inpatient Evaluation
   3. Outpatient Dysphagia
   4. Outpatient Voice Therapy
   5. Pediatric (i.e., FEES)
7. Audiology: 2x/month
   1. Adult outpatient routine audiograms
   2. Pediatric Evaluation & ABRs
   3. Newborn hearing screen
   4. Cochlear Implant Evaluation
   5. Hearing Aid Evaluation
8. Global Health - an optional week during a 3-month block
   1. Requires a letter from the trip leader
   2. Requires approval from PD and Chair
   3. Work week should involve a minimum of 40 hrs medical mission work
   4. If more than one week, the resident must use vacation time
9. Research - dedicated time for specific research study upon approved request
   1. Maximum time = 1 month
   2. Identify mentor
   3. Submit a proposal for approval to
      1. Research director
      2. Program director
      3. Chair
   4. Proposal format same as PGY4 projects
   5. The proposal should also include a weekly work plan
      1. If approved, the resident must submit weekly progress reports to their mentor

Learning Objectives:

Plastics

Individual learning plan (ILP) with at least three medical knowledge and at least three technical objectives.

Example:

Medical knowledge (use COCLIA as reference):

1. Compare and contrast external vs. endonasal rhinoplasty
2. Describe options for hair restoration
3. What are the considerations in a revision rhytidectomy?

Technical objectives:

1. Perform photo documentation and describe a surgical plan for a preop rhinoplasty, blepharoplasty, and chin augmentation patient
2. Describe injectable and filler options for aging face and perform injection of both botox and filler.
3. Participate in a scar revision and/or skin resurfacing procedure

Laryngology

Medical knowledge:

1. The use of EMG in the diagnosis of laryngeal disorders
2. Objective measures of voice disorders (shimmer, jitter, S-Z ratio, maximum phonation time)
3. Differentiate adductor, abduction, muscle tension dysphonia
4. The principles of thyroplasty (type 1-4)

Technical objectives:

1. Perform in-office biopsies and laser procedures
2. Botox injection for spasmodic dysphagia (adduction and abductor)
3. Percutaneous injection laryngoplasty

General

To be created by PGY-3

Assigned subspecialty clinics

Otology

Medical knowledge:

1. Discuss medical and surgical options for otosclerosis
2. Review pros and cons of different surgical approaches to acoustic neuromas
3. Explain CPG for sudden SNHL

Technical objectives:

1. Perform an effective Epley maneuver
2. Demonstrate ability to anesthetize the tympanic membrane
3. Perform an in-office myringotomy
4. Do an intratympanic steroid injection

Allergy

Medical knowledge:

1. Explain work up of food allergies
2. Describe the pathophysiology of angioedema
3. Review differences between RAST and intradermal testing

Technical objectives:

1. Place and interpret intradermal testing
2. Develop a treatment plan involving comprehensive environmental control for an atopic patient
3. Plan contingency for anaphylaxis

Skull base

Medical knowledge:

1. Compare and contrast open vs. endoscopic approach to anterior skull base lesions
2. Explain methods for intranasal CSF diagnosis and treatment
3. Differentiate resectable vs. unresectable skull base lesions
4. Explain the different reconstruction techniques for skull base defects from small to large

Technical objectives:

1. Read MRI and CT imaging of skull base tumors
2. Demonstrate facility with flexible and rigid endoscopes in examining skull base lesions
3. Perform endoscopic guided cultures and/or biopsies

Rhinology

Medical knowledge:

1. Create a formal workup and treatment plan for ARS, CRS, CRS w/ polyposis, allergic rhinitis, non-allergic rhinitis, and fungal rhinitis.

Technical objectives:

1. Master rigid nasal endoscopy with 0 and 30-degree scopes using the 3-pass technique, including in-office biopsy of nasal mass
2. In-office endoscopic debridement post FESS, including removal of propel stents.
3. Perform an UPSIT and interpret the result
4. Cryoablation or in-office balloon sinuplasty (optional if available)

Speech

Medical knowledge:

1. Understand the different swallowing maneuvers involved in treating dysphagia (head turn, head tuck, etc.) and its indications for use
2. Discuss different laryngeal speech options following laryngectomy
3. Differentiate different voice therapy techniques for VF nodules, muscle tension dysphonia, paradoxical VF motion, and others.

Technical objectives:

1. Participate in a FEES and understand the sequence of administration of different consistencies based on patient performance.
2. Perform a preoperative discussion and postop inpatient evaluation of a laryngectomy patient.
3. Perform and interpret a modified barium swallow

Audiology

Medical knowledge:

1. Explain how newborn hearing screening is done and interpret the results. Understand the difference between TEOAE and DPOAE. If there is an abnormal NBHS, discuss the next options in the workup.
2. Describe different hearing amplification options for a child with unilateral & bilateral CHL and SNHL.
3. What hearing aids are available to adults?

Technical objectives:

1. Perform and interpret a routine audiogram with tympanometry. Also, perform a visual reinforced audiometry in CHAM.
2. Perform and interpret an ABR
3. Assist in programming a cochlear implant
4. Perform balance function tests for vestibular dysfunction (rotary chair, VEMPs, calorics)