PGY4 Goals and Objectives
Clinical training in the PGY4 year is spent working in four different three-month rotations:
Pediatric otolaryngology at University of Minnesota (all residents)
General otolaryngology-VA (all residents) (focus on head and neck oncology)
General otolaryngology-HCMC (all residents)
General otolaryngology-Regions (all residents)
Goals:
An increased emphasis on operative skills is placed on this year. More independence of
thought in the clinic as well as inpatient management occurs in this year.
1. Pediatric Otolaryngology: Residents will complete three months of dedicated pediatric
otolaryngology training at University of Minnesota Medical Center with fellowship trained
pediatric otolaryngology staff. This will include tertiary pediatric otolaryngology and craniofacial
surgery, with continued exposure to pediatric endoscopy, otology and airway reconstruction,
2. General Otolaryngology—VA: At the VA, the emphasis will continue to be on head and neck
oncology.
3. General Otolaryngology-Regions: At Regions Hospital, the emphasis will continue to be on
trauma as well as facial plastic and reconstructive surgery. This rotation will include more
exposure to facial plastic procedures, i.e. rhinoplasty, blepharoplasty, and facial enhancement.
4. General Otolaryngology—HCMC: HCMC will also provide continued experience in trauma,
as well as in sinonasal surgery and laryngology. This rotation will also include continued
exposure to laryngology cases, sinus surgery, and a strong emphasis on adult otology.
PGY4 Objectives:
The objectives for PGY4 ENT training follow. Learning objectives are
organized by each ACGME core competency.
Medical Knowledge:
Upon completion of the PGY4 year of training the resident will be expected
to demonstrate an evolving mastery of Otolaryngology/Head and Neck Surgery, including:
Medical and surgical aspects of otology and neurotology
Medical and surgical aspects of head and neck oncology
Medical and surgical aspects of sinonasal problems
Medical and surgical aspects of plastic and reconstructive cases
Medical and surgical aspects of advanced cases in pediatric otolaryngology,
including congenital defects and airway problems.
Knowledge level demonstrated by above average performance, as compared to Program Year
peers nationally, on annual in-service examination.
Patient Care:
Upon completion of the PGY4 year of training the resident will be expected to:
Obtain thorough and appropriate medical histories from patients presenting with
congenital defects
Develop and implement treatment plans for adult and pediatric patients presenting
with complex problems in both inpatient and ambulatory settings
Patient Care—Procedural Skills:
Upon completion of the PGY4 year, residents are expected to
demonstrate proficiency in the following procedures:
Major head and neck procedures including:
Parotidectomy
Thyroidectomy
Radical neck dissection
Major vessel surgery
Nerve granftgi
Craniofacial resection and other ablative procedures
Plastic procedures including:
Myocutaneous flaps
Rhinoplasty
Rhytidectomy
Blepharoplasty
Facial reanimation
Management of craniofacial trauma
Communication Skills:
Upon completion of the PGY4 year, residents are expected to:
Effectively supervise more junior residents in the clinic as well as in the operating
room
Work effectively as leader of the health care team by substituting for the Chief
Resident when the Chief Resident is absent
Practice-Based Learning and Improvement:
Upon completion of the PGY4 year, residents are
expected to:
Participate in the education of patients, families, students, residents and other health
professionals
Set appropriate learning and improvement goals based on self-identification of
strengths, deficiencies, and limits in knowledge and expertise
Professionalism:
Upon completion of the PGY4 year, residents are expected to:
Demonstrate a commitment to excellence by engaging in activities that foster
personal and professional growth as a physician
Systems-Based Practice:
Upon completion of the PGY4 year, residents are expected to:
Incorporate considerations of cost awareness and risk-benefit analysis in patient
and/or population-based care as appropriate
PGY4 Research Skill Development:
During the PGY4 year, the resident should begin data analysis and drafting a publication.
The resident may participate with a faculty member in submission for grant funding, learning the
method of grant preparation for various funding sources, and IRB requirement.
Presents findings of required project or other research at local, regional or national meeting.
Submits article for publication.
Carries out other guided research projects with faculty (may be other than research mentor).
By April 15th, the PGY4 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 the PGY4 residents are as follows:
Supervise PGY-1, -2, and -3 residents
Observe PGY3 residents and instruct them in clinic as well as in the operating room.
Supervises PGY3 residents in the operating room for the following cases:
panendoscopy, tracheotomy, septoplasty, turbinectomy, and basic facial fractures.
Participate in major otologic surgery including middle ear exploration, acoustic,
stapedectomy, mastoidectomy, tympanoplasty, excision and reconstruction of aural
atresia.
As plastics resident, participate in all plastic procedures performed.
Participate in major head and neck as well as other major cases.
Substitute for the chief resident while the chief is absent.
Participate in all major Otolaryngological surgeries in all realms of the specialty,
including Plastics, Otology, Head and Neck surgery and Pediatric otolaryngology.
Major head and neck procedures include parotidectomy, thyroidectomy, radical neck
dissection, major vessel surgery, nerve grafting, craniofacial resection and other
ablative procedures. Plastic procedures include myocutaneous flaps, free grafts,
rhinoplasty, rhytidectomy, blepharoplasty, and facial reanimation.
Perform endoscopic sinus surgery under staff supervision.
Perform medical histories and physical examinations and record them in patient
charts. Formulate diagnosis and treatment plans.
Write progress notes and doctor’s orders in electronic medical record.
Progression of Responsibilities
By functioning as a senior Resident, by serving as the Pediatric Senior in charge of
the Pediatric Otolaryngology service, by substituting when the Chief is away, and by
taking back-up call overseeing more junior residents, the third year resident acquires
skills that prepare him/her for the increasing responsibilities as a year four resident.
May assume some administrative duties as delegated by the Program Director.
May act for Chief Resident in their absence.
Permitted to perform all the above and all procedures that a PGY-3 resident may
perform, plus the following additional procedures listed below.
These procedures are performed under the direct visual supervision of an attending
physician.
Clinical Skill Progression
Middle ear exploration
Acoustic
Stapedectomy
Mastoidectomy
Tympanoplasty
Cochlear implantatio n
Excision and reconstruction of aural atresia
Parotidectomy
Thyroidectomy
Radical neck dissection
Major vessel surgery
Nerve granftgi
Craniofacial resection and other ablative procedures
Myocutaneous flaps
Free grafts
Rhinoplasty
Rhytidectomy
Blepharoplasty
Facial reanimation
Endoscopic sinus surgery (adult and pediatric)
Pediatric airway endoscopy
Laryngotracheal reconrsutction
Surgery of complex pediatric head and neck tumors (i.e. lymphangioma /
hemangioma)