PGY3 Goals and Objectives
Clinical training in the PGY3 year is spent working in two different three month rotations:
Head and neck oncology at University of Minnesota (all residents)
General otolaryngology/head and neck oncology-VA (all residents)
Research training: ( will updated 2021-2022 all research in year 3 )
The remaining six months are spent in research. Flexibility is allowed in
scheduling research, so that some residents will complete only 3 months of research during the
PGY-3 year, with the remaining 3 months completed during the PGY4 year. If only 3 months of
research occurs during this year then an additional clinical rotation is provided in
general/trauma/plastics at Regions Hospital or Hennepin County Medical Center. Goals for that
rotation are included with PGY4 year goals and objectives.
Clinical Goals:
The overall emphasis continues on development and comfort with basic
examination, evaluation and development of differential diagnosis. There is still an emphasis of
time in the clinic compared to the operating theater, but gradual progression with increasing
time spent in the operating theater will occur. The emphasis of training during this year is in
head & neck oncology.
1. Head and Neck Oncology: Residents will complete three months of dedication Head and
Neck Oncology training at the University of Minnesota Medical Center with fellowship trained
head & neck oncology staff. In addition an introduction to advanced plastics will occur which
includes microvascular and free tissue transfer as well as traditional pedicle flap reconstruction.
2. General Otolaryngology/Head and Neck Oncology—VA: Continued exposure to general
otolaryngology will round out the PGY3 education. Exposure to Head and Neck Oncology will
also occur at the VA in the Head and neck tumor conference and in the operating room.
PGY3 Objectives:
The objectives for PGY3 ENT training follow. The learning objectives are
organized by each ACGME core competency.
Medical Knowledge:
Upon completion of the PGY3 year of training the resident will be expected
to demonstrate knowledge of:
Principles of radiologic oncology, laser physics, wound healing, laryngeal physics,
voice measurement, language development, acoustics, auditory brainstem response,
otoacoustic emissions, impact of hearing loss
Physiology of small vessels (via microvascular surgery exposure)
The rationale, content and implementation of diagnostic workup for neoplasms
The rationale and methodology for fracture evaluation, and the dynamics of fracture
reduction (at University or if rotating at HCMC / Regions)
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:
Upon completion of the PGY3 year of training the residents will be expected to:
Obtain thorough and appropriate medical histories from patients presenting with
facial fractures or with head and neck cancer
Present appropriate diagnostic workup for neoplasms, including literature review
and case presentation at the interdisciplinary Head and Neck Tumor Board
(University and VA)
Present appropriate diagnostic workup for fracture reduction to the Facial Trauma
attending on call (University or Regions / HCMC)
Patient Care--Procedural Skills:
Upon completion of the PGY3 year, residents are expected to
demonstrate proficiency in the following procedures:
Improvement of procedural skills developed as a PGY-2 resident
Repair techniques for small vessels
Laser surgery including CO2, YAG and Argon beam after proper requirements are
met (under direct visual supervision of Attendings).
Submandibular gland excision
Thyroglossal duct cyst excisions
Septoplasty
Turbinectomy
Basic nasal endoscopy including minimal FESS as well as Caldwell Luc procedure
Fracture management
Communication Skills:
Upon completion of the PGY3 year, residents are expected to
Establish and maintain professional and therapeutic relationships with patients and
healthcare team members
Consult appropriately with oncological services in the multidisciplinary care of head
and neck cancer patients
Effectively present cases, including literature review, to interdisciplinary head and
neck tumor board
Communicate effectively with cancer patients and their families, including discussion
of end-of-life decisions
Teach medical students and PGY2 residents
Practice Based Learning and Improvement:
Upon completion of the PGY3 year, residents are
expected to:
Demonstrate behaviors that reflect an ongoing commitment to continuous
professional development, ethical practice, sensitivity to diversity and responsible
attitudes
Systematically read to improve patient care
Seek feedback from a variety of team members and integrate it into practice to
improve performance
Professionalism:
Residents are expected to:
Be attentive to ethical issues.
Accept responsibility for continuity of care;
Be involved in end-of-life discussions and decisions.
Practice patient-centered care that encompasses confidentiality, respect for privacy
and autonomy through appropriate informed consent and shared decision-making
Systems-based practice:
Upon completion of the PGY3 year residents are expected to:
Coordinate care within the health care system
Work in interprofessional teams to improve patient care quality
Rotation goals and objectives:
Head and Neck Oncology Rotation (University of Minnesota Medical Center):
Upon completion
on the head and neck oncology rotation at UMMC residents will be expected to:
Develop medical and surgical management plans for diseases of the major and
minor salivary glands.
Explain mechanisms of carcinogenesis of upper aerodigestive cancers in the context
of abnormalities of the critical elements of cell cycle regulation.
Appropriately assess (e.g., staging endoscopy, CT and MRI imaging, and FNA) and
apply staging parameters of squamous cell and non-squamous cell neoplasms of the
head and neck in presentation of patients to Head and Neck Tumor Board,
understanding of the relationship between clinical stage, treatment recommendation,
and prognosis. .
Use of diagnostic procedures for diseases of the esophagus including the
identification of abnormalities involving manometry, ph monitoring, and
esophagoscopy.
Apply knowledge of multi-organ system risk factors towards the management of
postoperative complications in patients undergoing OHNS surgical treatment.
VA General Otolaryngology Objectives:
Upon completion of the PGY3 general otolaryngology
rotation at the VA residents will be expected to:
Demonstrate expertise in the complete office-based physical exam of the head and
neck, including teaching medical students and PGY2 residents
Demonstrate advanced skills in the performance of indirect mirror flexible and rigid
laryngoscopy.
Discuss the measures of immune suppression in head and neck cancer and their
biologic basis
Create a treatment plan including assessment and management for the patient with
thyroid nodule / goiter / cancer.
Establish guidelines for the surgical and medical management of patients with
hyperthyroidism.
Describe criteria for the surgical management of Grave's ophthalmopathy, and the
ocular complications.
PGY3 Research Skill Development:
As part of the program structure, residents are provided with six months of time for conducting
research. Beginning in the PGY3 year, the resident should spend 6 months conducting basic
science or applied clinical research with guidance and supervision by qualified faculty. The
resident should participate in the development of new knowledge, learn to evaluate research
findings, and develop habits of inquiry as a continuing professional responsibility.
By April 15th, the PGY3 resident should submit a written research progress report to the Chair of
the Department’s Graduate Research Committee
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 PGY3 residents are as follows:
Performs all responsibilities under direct visual supervision; progressively adds
additional procedures and responsibilities to armamentarium.
As Tumor Resident, presents tumor cases at tumor conferences. Under guidance of
Attendings, organizes the content of presentations for this conference.
Performs Panendoscopy (direct laryngoscopy, esophagoscopy and bronchoscopy) in
the operating room.
Performs laser procedures of the head and neck
Assists in all tumor surgical cases at the University.
As a Consulting Resident, is responsible for seeing and following adult consults
service, as well as tending to adult ER consultations. This resident should formulate
a plan and institute it after discussing the cases with the chief and/or Attending.
Carries out mandible, trimalar and other basic fracture cases.
Other surgeries include laryngectomies, neck dissections of all types, pharyngeal
resections, laryngeal sparing procedures, parotidectomies, submandibular gland
excision, thyroid surgery, thryoglossal duct cyst excisions, septoplasty, turbinectomy,
and basic nasal endoscopy including minimal FESS as well as Caldwell Luc
procedures.
Assists on major surgical procedures.
Develops skill with lasers including CO2, YAG and Argon beam after proper
requirements are met. These surgeries should be performed under direct visual
supervision
Attends rounds every AM & PM and is expected to take night call from home.
Attends all required courses and Grand Rounds.
Progression of Responsibilities
By being in charge of the adult and ER consults, formulating diagnoses and
treatment plans with the Attending and Chief Resident, organizing the
multidisciplinary Tumor Board conference, and by operating, the PGY3 resident
acquires skills that prepare him/her for the increasing responsibilities as a PGY4
resident.
Permitted to perform medical histories and physical examinations and to record such
in patient charts. Also, formulation regarding diagnosis, treatment plans, progress
notes and doctor’s orders may be recorded in patient charts.
Permitted to perform all the above and all procedures that a PGY-2 resident may
perform, plus the following additional procedures listed below.
These procedures are performed under the direct visual supervision of an attending
physician.
Procedures
Submandibular gland resection
Parotid gland resection
Incision and drainage of neck abscess
Neck dissections of all types
Local resection of mouth malignancy
Laser resection of head & neck malignancy
Endoscopy (bronchoscopy [rigid & flexible])
Esophagoscopy (rigid & flexible)
Laryngoscopy (rigid & flexible)
Endoscopic sinus surgery
Laryngectomy (total and modified)
Mandibular resectio n
Pharyngeal resectio n
Thyroid surgery
Local and regional reconstruction
Free tissue transfer
Laryngeal resections (total / partial)
Parotidectomies