PGY1 Goals and Objectives

Locations:

St. Paul (Regions); Hennepin County Medical Center, Minneapolis (HCMC), and Minneapolis

VA Health Care System (VA)

The Otolaryngology Program Director is responsible for the design, implementation and

oversight of the PGY1 year. Scheduling of PGY1 rotations is done in conjunction with the

Surgery Program Director at Hennepin County Medical Center, as permitted by ACGME.

Rotations are intended to meet ACGME requirements for the PGY1 year. Effective in 2016,

ACGME requirements for the PGY-1 year include:

• six months of structured education on non-otolaryngology rotations designed to foster

proficiency in the perioperative care of surgical patients, inter-disciplinary care

coordination, and airway management skills; and,

• The total time a resident is assigned to any one non-otolaryngology rotation must

be at least four weeks and must not exceed two months.

• Rotations must be selected from the following: anesthesia, general surgery,

neurological surgery, neuroradiology, ophthalmology, oral-maxillofacial surgery,

pediatric surgery, plastic surgery, and radiation oncology.

This must include an intensive care rotation.

• six months of otolaryngology rotations designed to develop proficiency in basic surgical

skills, general care of otolaryngology patients both in the inpatient setting and in the

outpatient clinics, management of otolaryngology patients in the emergency department,

and cultivation of an otolaryngology knowledge base.

GENERAL SURGERY, TRAUMA, VASCULAR, THORACIC and PLASTIC ROTATIONS

Patient Evaluation, Assessment, and Management

By the completion of PGY-1, the resident should be knowledgeable in the following areas and

be able to do:

History and Physical Examination, Documentation

• Obtain a detailed surgical history and obtain and review relevant medical records and

reports

• Perform a detailed physical examination.

• Develop a complete differential diagnosis.

• Maintain a personal patient log.

Write a succinct H&P, including a risk assessment evaluation.

• Obtain a written informed consent.

• Document the treatment plan in the medical record, including the indications for

treatment.

• Dictate an operative note and discharge summary.

• Write daily patient progress notes by hand or electronically

• Understand and successfully use the electronic medical record system for notes,

orders and X-rays

Patient Assessment and Perioperative Management

Order and interpret basic laboratory tests and screening X-Rays, and evaluate the

patient’s cardiac, pulmonary, renal, and neurological status.

• Develop a preoperative assessment of risk factors.

• Review, prioritize, and order medications the patient is currently taking, as appropriate.

• Use and understand the nursing notes and patient data including by an electronic

system.

• Prescribe activity level, management of medications, pain management, follow up

appointments, and obtain urgent contact information.

Assessment of Basic Diagnostic Tests and X-Rays

• Recognize abnormalities in basic radiologic and laboratory tests and learn normal

values and ranges.

• Choose the optimal imaging technique.

• Recognize:

pleural effusion on CXR

chest mass on CXR

pneumonitis on CXR

bowel gas patterns on flat plate abdomen

diaphragm abnormalities on CXR

spinal column fractures

cervical spine radiographs

• Interpret basic EKG findings

• Recognize ischemia & arrhythmia patterns on EKG.

Management of Fluid/Electrolyte and Acid Base Balance

• Understand acid-base balance and the applications of body composition to fluid,

electrolyte, and acid-base balance in health and disease.

• Give fluid resuscitation, manage postoperative fluid requirements, and recognize and

correctly manage acid-base disorders.

• Make adjustments in fluid administration for comorbid conditions, e.g. renal or cardiac

insufficiency, diabetes, hypovolemia.

• Use CVP and urine flow rates for adjustments of fluid administration.

• Perform a saphenous cutdown.

• Recognize and treat calcium and magnesium imbalance.

Fever, Microbiology, and Surgical Infection

Know the mediators of fever, differential diagnosis, evaluation and management of the

febrile patient in order to initiate appropriate workup of fever and provide supportive

treatment.

• Initiate definitive treatment with appropriate antibiotics.

• Be able to monitor antibiotic levels and recognize drug-related complications. Know the

antibiotic of choice.

• Know and apply the principles of prevention of nosocomial infections, sterile technique

and universal precautions.

• Order and interpret the appropriate imaging studies for localization of an infected focus.

• Know and apply the principles of incision and drainage.

• Know the proper use of prophylactic antibiotics.

• Know the classification of wounds (clean, clean-contaminated, contaminated, infected).

• Recognize the septic syndrome and initiate appropriate supportive treatment. Be

familiar with the current literature concerning the causes and mediators of the sepsis

syndrome and its pathophysiology.

Epidemiology and Public Health

Be knowledgeable in AIDS diagnosis and prevention of HIV infection.

• Understand the epidemiology and treatment of sexually transmitted diseases and other

communicable diseases.

Nutrition

• Perform a metabolic assessment of the surgical patient.

• Understand the metabolic implications of trauma and operation.

• Know the indications for nutritional support of the surgical patient.

• Know the methods of calculation of nutritional requirements in health and disease using

the Harris-Benedict or similar formulae.

• Know the composition of various enteral and parenteral formulas and adjust

appropriately.

• Calculate and order basic enteral or parenteral formulas.

• Recognize complications of enteral and parenteral feedings.

• Manage central IV lines.

• Manage gastrostomy or jejunostomy feeding tubes.

• Assess when a postoperative patient can be fed and assess adequacy of intake.

• Know and utilize comparative costs of nutritional support methods.

Perioperative Preparation

• Complete, document, and assess appropriate workup, write preoperative orders, and

obtain required consultation from other specialists.

Surgical Skills

Learn surgical site positioning, preparation and draping.

• Perform as first assistant. Know how to obtain hemostasis of small vessels and

exposure of the operative field.

• Be familiar with common surgical instruments (scalpel, forceps, scissors, needle

holders, hemostats, retractors, electrocautery) and suture materials and their proper

uses.

• Perform basic maneuvers, e.g. suture of skin, soft tissues, fascia; tie knots; obtain

simple hemostasis.

• Learn basic techniques of dissection and handling of tissues.

• Under supervision:

excise benign lesions of skin and subcutaneous tissues.

perform lymph node biopsy.

remove superficial foreign bodies.

incise and drain an abscess.

repair simple lacerations.

repair umbilical and type I and II inguinal hernias.

perform appendectomy.

Sterile Technique

• Understand indications for and utilize appropriate methods of routine and reverse

isolation procedures.

• Maintain appropriate sterile technique in the ER, at the bedside, in the ICU, and in the

office.

Wound Management

• Differentiate between wound infection, hematoma, and seroma, and initiate therapy.

• Perform extensive debridement with supervision.

• Debride and pack wounds and apply dressings.

• Recognize and differentiate between wound infection and necrotizing fasciitis, and

detect crepitus.

• Identify wound dehiscence and evisceration.

• Know and apply the specific recommendations for tetanus immunization (active and

passive).

• Know the clinical manifestations of rabies in carrier and patient, and agents available to

prevent development of the disease.

• Obtain proper wound specimen and perform and interpret Gram stain.

Prioritize and Manage Complications

• Assess and manage complications or change in health status, such as:

altered mental status.

fever.

hypotension.

hypovolemia, oliguria.

hypoxia.

pain .

vomiting, distention, nausea.

bleeding at the bedside & coagulopathy.

atelectasis, pneumonia, aspiration.

fecal impaction, constipation

chest pain,

dyspnea

pneumothorax

congestive heart failure, pulmonary edema

superficial phlebitis,

pulmonary embolus

urinary retention

diabetic ketoacidosis or hyperosmolar coma

peripheral ischemia or cyanosis

seizures, alcohol or drug withdrawal

Thoracic Surgery Rotation

The main goal of this rotation is to provide the PGY1 resident an organized experience to

enable him/her to acquire the basic knowledge and skills in the evaluation and management of

patients with common cardiac and pulmonary surgical problems.

At the completion of this rotation the PGY1 resident should be knowledgeable in the following

areas and be able to do:

• Review applied cardiac physiology and applied pulmonary physiology

• Critical care and management of shock

• Basic surgical skills.

• Evaluation and management of chest masses

• Care for at least 15 ICU patients/month

ANESTHESIA, CRITICAL CARE, EMERGENCY MEDICINE, AND NEUROSURGERY

ROTATIONS

Anesthesia Rotation

The main goal of this rotation is to provide the PGY1 resident an organized experience to

enable him/her to acquire the basic knowledge and skills in preoperative care including

preanesthetic evaluation, anesthetic risk assessment, airway evaluation and immediate

postoperative care.

At the completion of this rotation the PGY 1resident should be knowledgeable in the following

areas and be able to do:

• Basic laryngeal anatomy and physiology.

• Appropriate indications for general vs. local anesthesia.

• Appropriate preoperative evaluation including when to order a pre-operative chest xray,

EKG, and laboratory tests based on the patient’s age, past medical history and

social habits.

• Write pre-anesthetic orders

• Obtain oropharyngeal control of airway and provide Ambu ventilation

• Be able to perform:

orotracheal intubation

nasotracheal intubation

laryngeal mask ventilation

jet ventilation

• Interpret the anesthesia record

• Position the patient properly for operative exposure, temperature control, and protection

from pressure/traction.

• Be familiar with intraoperative monitoring.

• Insert arterial and venous lines.

• Know the dose range and complications (including pulmonary edema and malignant

hyperthermia) of the following agents:

barbiturates

local anesthetics

paralyzing agents

reversing agents

inhalant anesthetics

• Know when and how to use epinephrine, hyaluronidase, in local anesthesia

• Under supervision:

administer a local block

administer general anesthesia

• Understand and use conscious sedation

• ACLS certification

Critical Care Rotation

The main goal of this rotation is to provide the PGY1 resident an organized experience to

enable him/her to acquire the basic knowledge and skills in the evaluation and management of

patients in the intensive care setting.

At the completion of this rotation the PGY 1resident should be knowledgeable in the following

areas and be able to do:

Critical Care and Management of Shock

• Differentiate types of shock (hemorrhagic, cardiogenic, septic, neurologic) and initiate

appropriate therapy.

• Insert central venous and arterial catheters and obtain hemodynamic data; interpret

data and initiate therapy.

• Recognize clinic presentation of a pneumothorax and insert chest tube

• Understand and utilize basic principles of mechanical ventilation.

• Recognize the indications for blood component therapy and initiate therapy.

• Recognize a transfusion reaction and initiate management.

• Institute measures to prevent upper GI bleeding in critically ill patients.

Coagulation and Anticoagulation

• Choose the appropriate tests for diagnosis of a coagulopathy, and have a working

knowledge of factor analysis.

• Apply effective preventive measures for DVT and PE.

• Initiate and monitor therapeutic anticoagulation and its complications.

• Diagnose and manage acute deep venous thrombosis.

• Acutely manage a patient with a suspected acute pulmonary embolus, and provide a

differential diagnosis.

Applied Cardiac Physiology

• Recognize rhythm disturbances, myocardial ischemia on EKG.

• Assess, formulate a differential diagnosis and initiate therapy for hypotension.

• Know and apply appropriate treatment for supraventricular tachycardia.

• Treat congestive failure and acute pulmonary edema.

• Manage hypertension in a surgical patient. Understand multidrug therapy and the toxic

and side effects of antihypertensive drugs.

Applied Renal Physiology

• Know the pathophysiology of the development of acute renal failure; the differentiation

of prerenal, renal, obstructive types of renal failure; and the general concepts of

prevention and treatment of ARF.

• Recognize and treat simple electrolyte disturbances.

• Understand appropriate fluid replacement and balance.

Applied Pulmonary Physiology

• Know the manifestations—clinical and by laboratory testing—of obstructive pulmonary

disease and pulmonary insufficiency, and their surgical perioperative management.

• Recognize bronchoconstrictive disorders and their perioperative management.

Applied Nutrition

• Learn to manage the nutritional needs of a critically ill patient.

• Placement of nasogastric tube and dophoff tube.

Surgical Skills

• Develop surgical skills in CPR, CVC placement, arterial catheter placement, and chest

tube placement.

• Perform first assistant in bedside bronchoscopy, pulmonary lavage, and tracheotomy.

• Obtain oropharyngeal control of airway, provide Ambu ventilation and perform

orotracheal intubation.

Emergency Medicine Rotation

The main goal of this rotation is to provide the PGY1 resident an organized experience to

enable him/her to acquire the basic knowledge and skills in the evaluation and management of

patients presenting to the emergency room with emphasis on patients presenting with head and

neck complaints. The PGY1 resident should also gain a better appreciation of medical

conditions often seen as co-morbidities in head and neck patients including, diabetes mellitus,

hypertension, stroke, congestive heart disease, respiratory distress and myocardial infarction.

At the completion of this rotation the PGY 1resident should be knowledgeable in the following

areas and be able to do:

• Conduct primary assessment and take appropriate steps to stabilize and treat patients

with trauma (penetrating and blunt), respiratory distress, congestive heart failure,

metabolic imbalances, myocardial infarction, and chronic pain.

• Establish the acuity level of patients in the ER, establish priorities and define the tasks

necessary to manage the patients successfully.

• Monitor, observe, manage, and maintain the stability of one or more patients who are

at different stages in their work-ups including fundamental lab tests and radiological

studies.

• Recognize and initiate treatment for an acute anaphylactic reaction.

• Collaborate with physicians and other professionals 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.

• Closure of simple and complex lacerations.

• Develop some familiarity with disaster management.

Neurosurgery Rotation

The main goal of this rotation is to provide the PGY1 resident an organized experience to

enable him/her to acquire the basic knowledge and skills in the evaluation and management of

patients presenting with neurosurgical complaints. The resident should gain an appreciation for

the collaborative efforts between the ORL and NES specialties.

At the completion of this rotation the PGY-1 resident should be knowledgeable in the following

areas and be able to do:

• Review basic cranial anatomy including cranial nerve origin and function.

• Perform neurosurgical patient evaluation, assessment and management.

• Learn evaluation and treatment of neurological trauma, critical care and emergencies.

• The indications for and basic interpretation of diagnostic tests and X-rays including

basic head CT and MRI imaging studies.

• Basic neurosurgical skills, technique, and wound management including simple

craniotomy, dural suturing and craniotomy closure.

• Recognition, diagnosis, and basic management of CSF leaks.

• Insertion and management of a lumbar drain.

• Management of common neurosurgical complications.

• Differentiate between stroke, TIA, and non-cerebrovascular events causing

neurological symptoms and know the diagnostic techniques.

• Participate in at least 5 major procedures (cranial decompression, craniotomy, removal

of pituitary adenoma)

• Understand neurosurgical procedures as it relates to Otolaryngology (suboccipital or

retrosigmoid approaches).

Otolaryngology-Head and Neck Surgery Rotation

The main goal of this rotation is to provide the PGY-1 resident with an introduction to basic

otolaryngology. At least 50% of the resident’s time will be spent in the clinical evaluation of outpatients

and the care of in-patients. Emphasis will be given on the management of

Otolaryngology emergencies and office procedures, and introduction and development of basic

surgical procedures:

• Understanding of the indications, risks, contraindications of a wide variety of

Otolaryngologic surgical procedures for adult and pediatric patients.

Knowledge level demonstrated by above average performance, as compared to Program Year

peers nationally, on annual in-service examination.

Clinical Skill development:

By the end of the first year of training, the resident should have been trained in the following

skills and procedures:

• Medical histories and physical examinations of the head and neck

• Evaluation and treatment of common adult otolaryngologic problems [both inpatient

and outpatient]

• Placement of IV’s; drawing blood; performing ABG’s

• Case presentations at morning and afternoon rounds

• Preoperative and postoperative evaluations of patients, admissions and discharges

• Management of the service with guidance from the chief residents and relevant

Attendings, and/or Director of Resident Education

• Triaging and initiating care of otolaryngologic emergencies [both adult and pediatric]

with supervision of Chief Residents and Attendings

• Performance of the following procedures: Tracheotomy, trach changes, tonsillectomy

and adenoidectomy, closed reduction of nasal fractures, microscopic otoscopy and

myringotomy and tube (M&T) insertion, fiberoptic laryngoscopy, flexible laryngoscopy,

fine needle aspiration biopsies, oral biopsies, minor surgical procedures (ear lobe repair,

incision and drainage, minor excisions, soft tissue trauma), microscopic ear examination

with cerumen removal, treatment of epistaxis.

Development of personal style should include:

self-assessment regarding work quality, ethical

practice; ability to work as part of a team, and within a health care network; short-term planning,

long-term planning; meticulous record keeping, including medical chart notes, informed consent,

clinical administrative reports as assigned; efficient work habits.

Progression of responsibilities:

By learning to evaluate inpatient and emergency consults, by

contributing to the post-operative care of a wide variety of Otolaryngology patients, by operating

as outlined below the first resident acquires skills that prepare him/her for increasing

responsibilities as a second year resident.

Research Skill Development

By the end of the first year of training, the resident should have visited the basic science

laboratories and clinical research areas and met with individual faculty to learn about faculty

research interests.