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