PGY2 Goals and Objectives

The clinical training in the PGY2 year is spent working in four different three month rotations:

• Pediatrics at Children’s Hospital (all residents);

• Otology at University of Minnesota (all residents);

• General otolaryngology-VA (all residents)

• General otolaryngology-HCMC (some residents)

• General otolaryngology-Regions (some residents)

All PGY-2 Residents are expected to attend the basic science curriculum that occurs throughout

the PGY-2 year. The course includes head & neck anatomy (cadaver dissection offered by the

Dept. of Anatomy, University of Minnesota), temporal bone anatomy dissection course, basic

science audiology and speech pathology, and basic science otolaryngology. In addition lectures

and guidance are given on the development of a research project.

Goals:

The overall emphasis in this year at all hospital rotations is to develop comfortable in the

clinic, inpatient areas and emergency room as well as develop a structured knowledge base to

formulate a differential diagnosis and logical reasoning. Introduction to the operating theater will

continue. The emphasis of training during this year is in Otology, Pediatric and General

Otolaryngology.

1. Otology:

Residents will complete three months of dedicated Otology training at the

University of Minnesota Medical Center with fellowship trained and board certified neurotology

staff. University of Minnesota Medical Center) is a tertiary care center that receives difficult

referral cases from the contiguous five-state area. PGY2 residents will work with a specific staff

or a team (head and neck, otology or pediatrics), and this will determine the type of problems

they will see.

2. Pediatric Otolaryngology:

Residents will complete three months of pediatrics

otolaryngology at Children’s Hospital taught by fellowship trained or recognized members of the

American Society of Pediatric Otolaryngology. A strong exposure to cleft lip and palate surgery

is provided.

3. General Otolaryngology--VA:

In addition, exposure to general otolaryngology rounds out

the PGY2 education. Exposure will occur to Head & Neck oncology at the VA.

4. General Otolaryngology—Regions or HCMC:

Continued experience with general

otolaryngology will occur either at Regions or HCMC. The focus of both of these rotations is on

continued exposure to general otolaryngology as well as trauma and facial plastics supervised

by the Department’s board certified or board eligible Facial Plastic Surgeons. Since HCMC is a

Level 1 Trauma Center, the greatest emphasis of the rotation will be on recognition and

management of urgent problems.

Regions Hospital is also a Level 1 Trauma and Burn Center, and some of the emphasis at

Regions will be the same as at HCMC. Additionally, resident will see a large number of patients

from foreign countries (e.g., Hmong, Vietnamese, Hispanic, Somalian) as well as patients

undergoing elective cosmetic reconstructive surgery.

PGY2 Objectives:

The objectives for PGY2 ENT training follow. The learning objectives are

organized by each ACGME core competency.

Medical Knowledge (MK):

Upon completion of the PGY2 year of training the resident will are

expected to demonstrate knowledge of relevant basic sciences as taught through the Basic

Science Course, including:

• Principles of anatomy, physiology, embryology, pathology, and genetics.

• Neoplasms, deformities, and; plastic and reconstructive surgery; and allergy,

endocrinology and neurology as they relate to the head and neck

• head & neck anatomy [through detailed dissections and lectures during the Head and

Neck Anatomy course, given by the Department of Anatomy at the University of

Minnesota to occur in July–August of the PGY-2]( moving to PGY1 year effective 2020-2021)

• temporal bone anatomy [through detailed dissection during the temporal bone anatomy

course during the Fall of the PGY-2]

• Indications, risks, contraindications of a wide variety of Otolaryngologic surgical

procedures for adult and pediatric patients.

• temporal bone anatomy, mastoid drilling technique, middle ear prostheses placement,

implantable hearing devices [Temporal Bone Course]

• methods of treatment of maxillofacial trauma using plating techniques

• anatomy of upper aerodigestive tract.

• major principles of the communication sciences (including audiology and speech

pathology and rehabilitation) as they apply to the practice of otolaryngology.

• physiology of the chemical senses

• pathophysiology of disorders of the ears, face, neck, and mandible

• major mechanisms of disease prevention

Resident’s acquisition and application of medical knowledge will be demonstrated by above

average performance, as compared to Program Year peers nationally, on annual in-service

examination

Patient Care (PC):

Upon completion of the PGY2 year of training the resident will are expected

to:

• Obtain thorough and appropriate medical histories from patients presenting with

disorders of the head and neck.

• Conduct appropriate physical examinations of the head and neck.

• Evaluate common adult otolaryngologic problems in both inpatient and outpatient

settings.

• Develop and implement treatment plans for patients presenting with common adult

otolaryngologic problebms in both inpatient and ambulatory settings.

• Properly place IV’s and draw blood.

• Perform ABG’s in emergent situations

• Perform preoperative and postoperative evaluations of patients, admissions and

discharges.

• Manage the service with guidance from the chief residents and relevant Attendings,

and/or Director of Resident Education

• Appropriately triage and initiate care of adult otolaryngologic emergencies with

supervision of Chief Residents and Attendings

Patient Care--Procedural Skills:

Upon completion of the PGY2 year, residents are expected to

demonstrate proficiency in 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 of the face and neck),

• microscopic ear examination with cerumen removal,

• treatment of epistaxis,

• ability to assess the trauma patient,

• basic nasal and aerodigestive endoscopy

Communication Skills (CS):

Upon completion of the PGY2 year, residents are expected to

• Effectively present cases at morning and afternoon rounds.

• Obtain thorough and appropriate medical histories from patients presenting with

disorders of the head and neck.

• Communicate effectively with patients and their families.

• Complete medical and administrative documentation in an effective and timely

manner.

Practice Based Learning and Improvement (PBLI):

Upon completion of the PG 2 year, residents

are expected to:

• Ask for feedback on performance

• Integrate relevant feedback into practice to improve performance

• Evaluate published literature in specialty and critically acclaimed journals and texts.

• Apply clinical trials data to patient management.

• Effectively access electronic information at point of care

Professionalism (P): Residents are expected to:

• Fulfill clinical and educational duties in an effective and timely manner

• Be receptive to feedback on performance.

• Be sensitive to gender, age, race, and cultural issues.

• Work effectively as a team member in all clinical settings.

• Respect patient confidentiality in all settings.

Systems-based Practice (SBP): Upon completion of the PG2 year residents are expected to:

• Work effectively as a team member.

• Recognize basic principles of patient safety

• Recognize basic issues of cost of care.

• Effectively serve as a consultant under the supervision of attending physicians and

upper level residents.

Rotation Goals and Objectives:

Otology Rotation (University of Minnesota Medical Center):

Upon completion of the general

otology/ neurotology rotation at UMMC residents will be expected to:

• Perform an initial otology consultation (PC, MK).

• Write an appropriate consultation note, to communicate with the staff and the senior

residents, and to communicate with other services as well (PC, CS, SBP).

• Evaluate patients with airway issues, chronic sinusitis, and other problems (MK, PC)

• Recognize differences when these diseases occur in patients who are immunesuppressed

or have other multiple medical problems (MK, PC).

• Perform a through history and physical examination on patients who have had an organ

transplant, bone marrow transplant, or who have been referred from an outstate hospital

evaluating not only ENT problems, but multiple other medical problems (PC).

• Assess complex patients in clinic with supervising faculty (MK, PC).

• Know the indications for operative procedures in patients with multiple high-risk

problems (MK, PC).

• Communicate effectively with multiple providers and staff in the care of complex patients

(PC, CS).

VA General Otolaryngology Objectives:

Upon completion of the general otolaryngology rotation

at the VA residents will be expected to:

• Provide effective otolaryngology consults for patients on other medical services. (PC,

SBP, CS)

• Effectively assess patients with long standing problems such as chronic hearing loss or

vertigo (MK, PC).

• Offer treatment options for patients long standing problems such as chronic hearing loss

and vertigo (MK, PC, SBP).

• Appropriately refer patients to other services, such as pulmonary for patients with

chronic lung disease or endocrine for diabetic patients, as a part of patient assessment

(PC, MK, SBP).

• Recognize indications and contraindications for ear surgery in patients with numerous

other medical problems (MK, PC)

• Evaluate patients with long-standing chronic ear disease using audiometric assessment;

scans and other laboratory testing when appropriate (MK, PC, SBP).

• Attend and present at weekly tumor conferences (MK, PC, CS, PBLI).

• Recognize which information is pertinent and critical for management of cancer including

associated medical problems and co-morbid conditions (PC, MK)

• Assess what type of surgical procedure is indicated, and whether surgery is appropriate

(MK, CS).

HCMC General Otolaryngology Objectives:

Upon completion the general otolaryngology

rotation at HCMC residents will be expected to:

• Perform appropriate initial assessment of patients with significant airway and facial

injuries including evaluation of the airway, evaluation of the cervical spine, and

evaluation of the need for immediate surgery (PC, MK).

• Effectively conduct assessment of airway issues in adults and children the emergency

room (PC, MK).

• Perform evaluation of patients with suspected neoplastic disease will be using

endoscopic procedures (PC, MK).

• Provide postoperative care of trauma patients in the intensive care unit or on the service

(PC, MK).

Regions General Otolaryngology Objectives:

Upon completion of the general otolaryngology

rotation at Regions Hospital residents will be expected to:

• Perform appropriate initial assessment of patients with significant airway and facial

injuries including evaluation of the airway, evaluation of the cervical spine, and

evaluation of the need for immediate surgery (PC, MK).

• Effectively conduct assessment of airway issues in adults and children the emergency

room (PC, MK).

• Perform evaluation of patients with suspected neoplastic disease will be using

endoscopic procedures (PC, MK).

• Provide postoperative care of trauma patients in the intensive care unit or on the service

(PC, MK).

• Effectively use the services of an interpreter to communicate with patients and families

that do not speak English.

• Appreciate and understand the severity and complexity of cultural issues in assessment

of patients (Prof, PC).

• Understand the principles of decision-making process for patients undergoing

reconstructive procedures (PC, MK).

Pediatric Rotation Objectives:

Upon completion of the Pediatrics rotation residents will be

expected to:

• Perform an appropriate head and neck examination of the pediatric patient.

• Diagnose common pediatric otolaryngology conditions

• Perform treatment of pediatric otolaryngology conditions, building on the initial

experience of the general otolaryngology rotations.

• Diagnose and manage pediatric airway, craniofacial, otologic, sinus and head and neck

problems.

• Effectively use fiberoptic nasopharyngoscopy, indirect laryngoscopy, microscopic

otoscopy, and pneumatic otoscopy and increase in the knowledge of abnormal anatomy.

• Describe the common and uncommon anomalies and conditions that may be

encountered in the pediatric head and neck exam.

• Perform perioperative management of patients who present to the pediatric

otolaryngology clinic

• Demonstrate basic proficiency in pediatric otolaryngology procedures:

myringotomy and tympanostomy tube placement

tympanoplast

tracheotomy

laryngoscopy

bronchoscopy

esophagoscopy

endoscopic sinus surgery (FESS)

arytenoidectomy/arytenoidpexy

laryngotracheoplasty/cricoid spli t

excision of nasopharyngeal angiofibroma

• Understand the indicators of potential complications that arise in the perioperative

period.

• Understand how to access additional services to provide care to children with

otolaryngology conditions (audiology, speech therapy, social services, etc…) (PC, SBP)

• Provide accurate and appropriate explanations of clinical conditions, treatment options

and risk/benefits to patient and their parents/guardians.

• Understand the process of obtaining informed consent for pediatric patients undergoing

procedures.

PGY2: Research Skill Development

During the summer of the PGY2 year, the resident should complete the Head and Neck

Anatomy dissection course.

During fall of the PGY2 year, the resident should complete the Physician Scientist/Thesis

Development course. This should introduce issues such as research ethics, IRB, sample

size/power, grant sources.

By October 1st of the PGY2 year, the resident should have identified an area of interest and

selected a preceptor and an area of research.

By November 1st, the resident should have begun preparing an application to AAO-HNSF for a

CORE grant, and should have discussed application requirements with both the preceptor and

the financial accounting support staff in the Department.

By December 15th, the resident should submit a Letter of Intent to AAO-HNSF, and by January

15th, should submit the grant application to AAO-HNSF.

By February 1st of the PGY2 year, the resident should prepare a two- to three-page preliminary

research proposal, including chosen advisor and tentative title, and should submit it to the Chair

of the Department’s Graduate Research Committee for approval. This proposal should provide

a brief background of the research problem being considered, a brief description of the

proposed study in general terms, and a budget page.

By June 1st of the PGY2 year, the resident should prepare a formal research proposal following

the format used in NIH grants, and submit it to the Chair of the Department’s Graduate

Research Committee for approval. Once approval is obtained, the resident should prepare a

budget with the help of the advisor, and submit the budget to an appropriate funding source.

By the end of the PGY2 year, in anticipation of research block time, the resident should have

made arrangements to have the laboratory ready with appropriate equipment, calibration, and

other measures to enable experimental procedures on the first block-time day.

Clinical Duties and Responsibilities:

All residents are expected to fulfill their clinical and

educational duties in an effective, timely and professional manner. The major duties and

expectations of PGY2 residents are as follows:

• Responsible for the daily care of the adult and pediatric inpatient service

• Performs medical histories and physical examinations

• Identifies and treats common problems, i.e. place IV’s, draw blood, perform ABG’s,

present at morning and afternoon rounds

• Performs preoperative and postoperative evaluations of patients, admissions and

discharges

• Manages the service with guidance from the chief residents and relevant Attendings,

and/or Director of Resident Education

• Required to be in clinic as assigned by the Program Director and/or Chief Resident

• Participates in the weekly basic science lecture series

• Attends all required courses and conferences

• Begins work on research requirement, above.

• As Pediatric First Year Resident, responsible for both the pediatric inpatient and

consult service. Daily care of the pediatric otolaryngology patients.

• Responsible for emergency room consults (with the supervision of an Attending and

Chief Resident)

• Organizes pediatric operations

• Mandatory attendance at pediatric and cleft clinic

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, and by being in charge of the tracheotomy service, the first-year resident

acquires skills that prepare him/her for increasing responsibilities as a second-year resident.

Clinical Skill Progression

Definitions used throughout this description regarding clinical procedures and

operations:

(1) General Supervision (the treatment/procedure is furnished under the

Supervising Physician’s overall direction and control, but the Supervising

Physician’s presence is not required during the performance of the

procedure/treatment).

(2) Direct supervision (the Supervising Physician must be present in the office

suite or in the unit (as applicable), and immediately available to furnish

assistance and direction throughout the performance of the

treatment/procedure. It does not mean that the Supervising Physician must

be present in the room when the treatment/procedure is being performed).

(3) Direct Visual Supervision: (the Supervising Physician must be in attendance

with the patient and the resident while supervising the performance of the

treatment/procedure).

Procedures are performed under direct visual supervision of an Attending

physician.

After a resident is duly assessed, the Attending will supervise directly the following

procedures:

o Tonsillectomy

o Adenoidectomy

o Tracheostomy

o Arterial ligation

o Uvulopharyngopalatoplasty

o Direct laryngoscopy/microlaryngoscopy

o Pediatric ednoscopy

o Cleft lip and palate (pediatric otolaryngology service is in charge of both the clinic

and surgery)

o Neck abscess drainage

o Maxillary sinus surgery/Caldwell-Luc

o Septoplasty

o Turbinate srugery

o Epistaxis management

o Flexible fiberoptic laryngoscopy

o Rigid nasal endoscopy

o Otologic microscopy

o Pneumatic otoscopy

o Rigid esophagoscopy

o Skin grafts

o Fine needle aspiration

o Peritonsillar abscess drainage

o Excision of congenital cyst and sinuses

o Tympanoplasty

o Mastoidectomy

o Cochlear implantation