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)