Detailed Rotations

PGY1– UT Surgical Interns Entering Otolaryngology

The 1st year residents will spend 2 months with the Otolaryngology service. Oto-PGY1’s spend their time at the VA, Allergy/Immunology Clinic, the OSA Sleep Clinic reading sleep studies, and rotating with the Oral & Maxillofacial Surgery team.

The first-year residents will spend four months with the General Surgery service, as required by the ACGME. These surgical rotations include:

• Pediatric Surgery at Le Bonheur Children’s Hospital 
• General Surgery at the VA  
• General ICU at Regional One Health 
• General Surgery/Nutrition at Regional One Health 

The interns will spend one month with Anesthesia at St. Jude Children’s Research Hospital and one month at the VA, splitting time between Ophthalmology and Radiation Oncology.

The first-year residents will spend 6 months with the Otolaryngology services. The rotations for those 6 months include: 

• Le Bonheur Children’s Hospital for two months
• Methodist University Head & Neck
• Baptist Memorial Hospital
• General clinic rotation, including Allergy/Immunology, Otology & Sleep Medicine
• Facial trauma at Regional One Health, splitting time with Oral & Maxillofacial Surgery

While on the otolaryngology services, they are expected to complete the above, progressively increasing expertise in each area. During these rotations, the resident will be strictly supervised and advised. By the end of these rotations, the resident should demonstrate beginning operative skills sufficient to perform very basic otolaryngology procedures with guidance, as well as begin developing and expanding their experience in the other objectives listed above. 

Didactics

PGY-1 residents are to participate in the required curricular activities of the respective services on which they rotate, but are invited to participate in such activities of the Otolaryngology department with the understanding that affairs of their primary service take priority. 

Goals and Objectives for the Surgical PGY-1 Resident: 

• Develop skills and knowledge base to assess, plan, and initiate management for adult and pediatric patients for medical and/or surgical problems.
• Develop the ability to evaluate and manage patients of all ages with medical and surgical emergencies, multiple organ system trauma, soft tissue wounds, injuries and medical conditions of the nervous system, and peripheral vascular and thoracic injuries.
• Develop the ability to evaluate and manage critically ill surgical and medical patients in both emergency room and intensive care unit settings.
• Participate in the intra-, pre- and postoperative care of surgical patients.
• Apply the principles of surgical anesthesia in both the hospital and ambulatory care settings, including anesthetic risks and the management of intraoperative anesthetic complications.

Goals and Objectives for the OTO-PGY-1 (Otolaryngology rotation only) Resident: 

• Serve as an effective member on the team of otolaryngology residents managing patients with disorders of the head and neck.
• Demonstrate an ability to manage with strict guidance the inpatient service and to assess consults.
• Perform an accurate assessment of patients in the ambulatory care setting and have a basic knowledge of disease management. 
• Communicate effectively with faculty and staff.
• Demonstrate a working knowledge of head and neck diseases with particular emphasis on head and neck neoplasms, acute airway problems, acute infections, trauma, chronic ear disease, and sinonasal disorders.
• Demonstrate operative skills sufficient to perform very basic otolaryngology procedures with minimal guidance.

OTO Year 1 (PGY-2)

This year is composed of either two residents or three residents (alternating years). When there are two residents, the residents spend six months at ROH and six months at the VA. Both are broken into 3 month blocks. When there are three residents, the residents spend four months at ROH, four months at the VA, and four months at Methodist.

The OTO-Y1 resident must:

General

• Efficiently and accurately assess patients in the outpatient clinic, including history and otolaryngic physical exam, rigid and fiberoptic endoscopy of the sinonasal tract/pharyx/larynx, and otomicroscopy.
• Participate in the hospital-based care of patients on the resident service, and those admitted by attending staff.
• Perform initial assessment of consultation patients, both in the hospital and in the emergency room, developing differential diagnoses and proposing treatment plans.
• Evaluate and manage of acute and chronic sinusitis, including interpretation of associated imaging studies, medical/allergy therapy, and postoperative care.
• Competently perform nasal septoplasty, maxillary antrostomy, anterior ethmoidectomy, turbinate reduction.
• Diagnose sleep disordered breathing syndromes, apply and interpret appropriate diagnostic imaging, and select appropriate management strategies, including CPAP. Perform general procedures such as tonsillectomy and UP3, and assist in more complex procedures.
• Develop skills in managing emergencies including airway obstruction, epistaxis, head and neck trauma, and serious head and neck infections. This includes performance of tracheostomy, abscess drainage, and nasal packing, anterior and posterior. Know the roles of the emergency department, radiology, and interventional radiology in the management of these conditions.
• Demonstrate operative skills sufficient to perform, with minimal guidance, general procedures such as those described above. Become familiar with the techniques of more complex operations, and serve as an effective operative assistant.

Otology

• Evaluate and manage, both medically and surgically, acute and chronic ear disease. This includes interpretation of audiometry and CT/MRI. Apply appropriate indications for these tests.
• Workup and manage SNHL, including the selection of amplification.
• Explain the differential diagnosis and perform an appropriate workup of balance disorders.
• Competently perform ventilation tube insertion, myringoplasty, cerumen removal, foreign body removal, and cavity debridement.

Head and Neck

• Distinguish benign from malignant from inflammatory lesions based on physical exam and office endoscopy, and apply appropriate workup and management algorithms.
• Select and interpret appropriate diagnostic imaging for head and neck neoplasms.
• Perform staging panendoscopy. Consolidate this data with that obtained from clinical and radiographic evaluation to accurately stage malignancies.
• Manage patients with head and neck neoplasia in conjunction with members of a multidisciplinary team.
• Manage the endocrinologic aspects of thyroid/parathyroid disease.
• Describe the histopathologic features of a lesion or neoplasm; distinguish benign from malignant tumors. Recognize common head and neck neoplasms such as squamous cell carcinoma, papillary thyroid carcinoma, pleomorphic adenoma, and basal cell carcinoma.

Trauma/Plastic/Reconstructive

• Describe the principles of aesthetic facial surgery, including facial analysis, and assist in the surgical procedures being performed in the private office setting.
• Perform a basic trauma evaluation, including application and interpretation of CT, plain films, and panorex.
• Evaluate and select reconstructive options after resection of head and neck neoplasms.
• Perform local flap reconstruction and skin grafting, full and split thickness.

During the first two weeks all residents undergo an orientation period regarding the running of the institution, particularly the computer system, the medical records system, the laboratory function, and specifics of the federal guidelines and requirements.

At the VA, all clinics and surgeries are supervised by attending VA staff. The three assigned residents work as a team, with the OTO-Y3 resident leading the team. Surgical exposure increases in complexity as appropriate to the resident level, proceeding from observation, assisting, to independent operating.

The OTO-Y1 resident, during the early part of the year is closely supervised. As the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is allowed progressively more independent responsibility, with supervision readily available. This rotation as with the other OTO-Y1 rotation acquires more experience and responsibility progressively increasing their independent operating exposure to prepare them for their role as an OTO-Y2 the following year.

The VAMC clinics are populated by veterans, who are usually older men. Approximately 5% of the patients are female. On Monday afternoon, Dr. Sebelik conducts a head and neck cancer clinic with new and follow-up patients.

Usually 25-35 patients are seen. All day Thursday and Friday morning, Dr. Hodges conducts a clinic where the residents see and treat general ENT problems such as: sinus problems, obstructive sleep apnea, ear problems, and hoarseness in about 65-70. Approximately 10-15 general ENT cases are seen on Friday afternoons. Dr. MacDonald is available on a consult basis with any questions regarding clinic patients or surgical cases in which neurotologic expertise is necessary.

The VA ENT service interacts actively with other services, specifically oral surgery, medical oncology, endocrinology and neurology in the management of our patients. They provide consultative services to all institutional departments.

All residents are required to attend all otolaryngology educational sessions during the VA rotation. Basic science topics are covered in the lecture series on an ongoing basis as well as extensively during the first year as part of the general surgery rotation between services. Residents are required to attend the VAMC Tumor Board Conference.

OTO Year 2 (PGY-3)

This year is composed of either two residents or three residents (alternating years). When there are two residents, the residents spend four months at Le Bonheur, four months on Research Rotation and four months at the Methodist.

When there are two residents the residents spend six months at Le Bonheur and four months on Research Rotation and two months at Methodist.

The OTO-Y2 resident must:

General

• Serve as an effective member on the team of pediatric and surgical residents managing patients with disorders of the head and neck in children.
• Demonstrate proficiency for effective management of inpatients, ability to diagnose and treat patients at the POB ENT clinic, accurately assess consults, and communicate effectively with faculty and staff.
• Evaluate and manage common head and neck diseases with particular emphasis on general pediatric otolaryngology, acute airway problems, acute infections, trauma, chronic ear disease sino-nasal disorders, otitis media and their surgical and medical treatments.
• Describe the pathophysiology and management of obstructive sleep apnea, chronic tonsillitis, chronic adenotonsillitis, strep throat, childhood neck masses and infectious diseases encountered in childhood, such as: retropharyngeal abscess diagnosis and treatment, acute cervical adnoiditis with abscess, irrigation and drainage, and the management of deep neck abscess.
• Evaluate and manage pediatric sinusitis: bacterial, fungal, and viral. Apply and interpret appropriate diagnostic imaging. Recognize and manage complications and pending complications of pediatric sinus disease.
• Master basic otolaryngology procedures including ventilation tube insertion, adenoidectomy, and tonsillectomy.
• Proficiently perform direct laryngoscopy, bronchoscopy, and esophagoscopy for diagnostic purposes and for removal of foreign body.
• Comfortably perform pediatric tracheotomies electively and emergency as well as manage the complication of these procedures.
• Describe and apply the proper settings, safety requirements, and techniques to use the carbon dioxide laser.
• Evaluate and manage causes of dysphagia and dysphonia in children and demonstrate the proper work up.
• Recognize and manage medically and surgically laryngeal papillomas.
• Demonstrate competency in the management of stridor including: Age-related differential diagnosis, the proper work-up, and surgical management of airway obstruction in a neonate, infant and child.
• Recognize the common systemic diseases in the pediatric population, and manage their otolaryngic manifestations.

Otology

• Evaluate and manage chronic ear disease, in the middle ear and mastoid, and its management. This includes medical therapy, ventilation tubes, tympanoplasty, ossicular implants, and mastoidectomy (simple, modified, radical).
• Carry out the workup and management of SNHL in the pediatric population, including syndromic, nonsyndromic, congenital, and acquired causes.
• Participate in the process of newborn screening and describe the importance of this endeavor.
• Apply the appropriate selection criteria (for candidacy) and surgical technique for cochlear implantation. Participate with patients, families, and other specialists in rehabilitation.
• Appropriately select and interpret audiologic, including OAE and ABR.
• Appropriately select and interpret radiologic data, including CT and MRI.

Head and Neck (augmented by St. Jude experience)

• Apply techniques involved in more complex operations, and with guidance, be capable of performing neck dissection, submandibular gland excision, and endoscopic sinus surgery.
• Participate in multidisciplinary management of children with oncologic disease, particularly as chemotherapy, radiation, and hematologic dysfunction affect the head and neck.
• Recognize the late treatment effects for childhood pediatric otolaryngologic neoplasms and the importance of providing effective follow-up care.

Trauma/Plastic/Reconstructive

• Apply factors unique to the pediatric population regarding the management of head and neck injuries.
• Explain the general systemic features of common congenital abnormalities that may affect the head and neck. Effectively participate in a multidisciplinary team approach for their management.
• Manage otolaryngic manifestations of congenital syndromes and malformations (such as cleft lip and palate, mandibulofacial dysostosis, craniofacial dysostosis.....) as they influence the airway, swallowing, cosmesis, and otologic disease.

The St. Jude component of this rotation has the following unique goals and objectives:

• Serve as an effective member on a multidisciplinary team managing pediatric patients with malignancies of the head and neck.
• Evaluate and manage head and neck diseases with particular emphasis on head and neck neoplasms, acute airway problems, acute infections, chronic ear disease post radiation and sino nasal disorders of the immunocompromised host.
• Apply techniques involved in more complex operations and with guidance, be capable of performing neck biopsies, submandibular gland excision, endoscopic sinus surgery, and tracheostomies.
• Manage these patients in the setting of co-morbidities including immunosuppression and coagulopathy.
• Evaluate and manage medical aspects of thyroid and parathyroid disorders and participate effectively with endocrinologist in the evaluation and treatment of these patients.
• Describe the role of all treatment modalities for head and neck malignancies including the care required for patients during the complete treatment period.
• Recognize the late treatment effects for pediatric otolaryngic neoplasms and the importance of providing effective follow-up care.

During the early part of the year the OTO-Y2 is closely supervised. As the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is allowed more independent responsibility, with supervision readily available. This rotation as with the other OTO-Y2 rotations increases the responsibility of the resident based upon their individual skills and progress. The OTO-Y2 acquires more experience and increased responsibility to prepare them for their role as an OTO-Y3 the following year.

At Le Bonheur, otolaryngology residents attend three clinics. Each of these is well covered by pediatric otolaryngology staff. A variety of patient conditions and age ranges, newborns through teenagers, are seen. The patient conditions range from otitis media to recurrent cholesteatoma; from recurrent tonsillitis to persistent neck mass. The residents also have the opportunity to see patients in the St. Jude clinics including immune compromised fungal sinusitis to a large variety of pediatric neoplasms and genetic diseases. In each of these clinics we see a variety of airway problems from obstructive sleep apnea to subglottic stenosis to extrinsic compression. These patients are scheduled for operative procedures. Residents assist in the procedures and follow the patients in these clinics afterward. We are fortunate to have rotations of 3-4 months to allow adequate follow-up.

OTO-Y2 Residents (Research)

A block of dedicated research time is performed during the OTO-2year. Under the guidance of Dr. Herb Gould, PhD, residents will undertake a project worthy of presentation at a major meeting and/or publication.* This may be either clinical or basic science in nature, and may draw upon the expertise and resources of members of the otolaryngology faculty and/or those of sister disciplines (allergy and immunology, oncology, radiation oncology, pediatrics, neurobiology, anatomy, surgical pathology, audiology, speech pathology…..)

The OTO-Y2 will:

• Learn and apply basic statistical analysis for analyzing scientific data.
• Learn and apply basic research design: develop the question, analyze existing data, form a hypothesis, develop an approach to answer the question and test the hypothesis, and execute this approach.
• Exhibit and promote ethical behavior in biomedical research.
• Explore cutting edge research topics and techniques available at our Medical Center.
• Present this research to the research conference for critical evaluation by the department.
• Present this data at a national or regional forum either as a poster or podium presentation.
• Submit this project for publication in the medical literature.
• Research requirements for graduation*:
  • During each academic year - submit at least one project for poster, podium presentation, or publication. This may be a case report.
  • Prior to graduation - every resident must have at least one project accepted for poster or podium presentation at a regional or national meeting, or for publication in the medical literature.

It is expected that each resident will demonstrate ongoing scholarly activity throughout the program. Drs. Gould, Yoo, and the other otolaryngology faculty will be available to promote continued development of these skills both within and outside of the dedicated research rotation. The ultimate goal is to equip each resident with the tools necessary to understand the scientific method, critically analyze the medical literature, maintain an inquisitive sense, and test hypotheses. These abilities are necessary for a successful lifetime of learning.

The University of Tennessee Biostatistics Department on this campus is available for consultation. The research resident covers Monday afternoons at the VA clinic and 5 weeks of vacation time for the residents at the VA, Le Bonheur and ROH. The remainder of the resident’s time (10 weeks) is devoted to research.

OTO-Y2 Residents (Methodist)

The OTO-Y2 resident must:

General

• Efficiently and accurately assess patients in the outpatient clinic, including history and otolaryngic physical exam, rigid and fiberoptic endoscopy of the sinonasal tract/pharyx/larynx, and otomicroscopy.
• Participate in the hospital-based care of patients on the resident service, and those admitted by attending staff.
• Perform initial assessment of consultation patients, both in the hospital and in the emergency room, developing differential diagnoses and proposing treatment plans.
• Evaluate and manage of acute and chronic sinusitis, including interpretation of associated imaging studies, medical/allergy therapy, and postoperative care.
• Competently perform nasal septoplasty, maxillary antrostomy, anterior ethmoidectomy, turbinate reduction.
• Diagnose sleep disordered breathing syndromes, apply and interpret appropriate diagnostic imaging, and select appropriate management strategies, including CPAP. Perform general procedures such as tonsillectomy and UP3, and assist in more complex procedures.
• Develop skills in managing emergencies including airway obstruction, epistaxis, head and neck trauma, and serious head and neck infections. This includes performance of tracheostomy, abscess drainage, and nasal packing, anterior and posterior. Know the roles of the emergency department, radiology, and interventional radiology in the management of these conditions.
• Demonstrate operative skills sufficient to perform, with minimal guidance, general procedures such as those described above. Become familiar with the techniques of more complex operations, and serve as an effective operative assistant.

Otology

• Evaluate and manage, both medically and surgically, acute and chronic ear disease. This includes interpretation of audiometry and CT/MRI. Apply appropriate indications for these tests.
• Workup and manage SNHL, including the selection of amplification.
• Explain the differential diagnosis and perform an appropriate workup of balance disorders.
• Competently perform ventilation tube insertion, myringoplasty, cerumen removal, foreign body removal, and cavity debridement.

Head and Neck

• Distinguish benign from malignant from inflammatory lesions based on physical exam and office endoscopy, and apply appropriate workup and management algorithms.
• Select and interpret appropriate diagnostic imaging for head and neck neoplasms.
• Perform staging panendoscopy. Consolidate this data with that obtained from clinical and radiographic evaluation to accurately stage malignancies.
• Manage patients with head and neck neoplasia in conjunction with members of a multidisciplinary team.
• Manage the endocrinologic aspects of thyroid/parathyroid disease.
• Describe the histopathologic features of a lesion or neoplasm; distinguish benign from malignant tumors. Recognize common head and neck neoplasms such as squamous cell carcinoma, papillary thyroid carcinoma, pleomorphic adenoma, and basal cell carcinoma.

Trauma/Plastic/Reconstructive

• Describe the principles of aesthetic facial surgery, including facial analysis, and assist in the surgical procedures being performed in the private office setting.
• Perform a basic trauma evaluation, including application and interpretation of CT, plain films, and panorex.
• Evaluate and select reconstructive options after resection of head and neck neoplasms.
• Perform local flap reconstruction and skin grafting, full and split thickness.

The OTO-Y2 during the early part of the year is closely supervised, but as the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is given progressively more independent responsibility, with supervision readily available. This rotation as with the other OTO Y2 rotations will progressively increase the responsibilities and surgical skills as the individual advances. The OTO-Y2 acquires more experience and responsibility to prepare them for their role as an OTO-Y3 the following year.

The Methodist Outpatient clinic meets one day a week. The resident’s average daily patient load is 10-15. The patient population is very diverse. As a result they see a variety of cancer patients, general otolaryngology patients and otology patients. This clinic is very productive, surgically speaking. On average, the residents book 2-3 surgical cases per clinic.

UT/Methodist Temporal Bone Lab is a fully equipped 10-station temporal bone lab located on the hospital grounds. Under the direction of Dr. Bruce MacDonald, a temporal bone course is held for residents twice each year. Additionally, all residents have access to the facility at any time, where frozen temporal bones are available 24/7.

Dr. Bruce MacDonald is the Medical Director of the Methodist Hearing and Balance Center and supervises the outpatient diagnosis and management of a large number of patients with auditory and vestibular disorders. He has successfully established an active cochlear implant program through this center.

Both the OTO-Y4 and OTO-Y2 enjoy this rotation because of the opportunity to work with outside volunteer faculty and to manage their own independent service. Faculty members take a more hands-off approach to this rotation thus allowing the OTO-Y4 to grow progressively into an independent otolaryngologist by graduation. Here the OTO-Y4 and OTO-Y2 work closely as a team with the OTO-Y4 mentoring and teaching the OTO-Y2 in an independent environment with supervision readily available.

OTO Year 3 (PGY-4)

OTO-Y3 Resident (MED-Trauma/Plastic and Reconstructive Surgery):

The resident is also responsible for managing the facial trauma service. This involves laceration repair and extensive facial trauma reconstruction. The resident fields calls to the emergency room, is primary surgeon, caregiver for the trauma patients who are served by this rotation.

The OTO-Y3 resident is responsible for managing any cosmetic or reconstructive patient seen at the Med Plex Clinic. This resident serves as primary surgeon on any surgery from this clinic.

The resident educational goal for Trauma/Facial Plastic and Reconstructive Surgery is one to expose the resident to the diverse medical care problems found in a mixed private cosmetics and public trauma center practice, so that they are familiar with the medical and surgical management of their populations. There is also a significant indigent patient population to augment their inner-city medical experience at the MED and thus provides an opportunity to learn to provide excellent care in both the private and indigent communities. To meet this goal the specific educational objectives below were developed. The residents are evaluated by their ability to achieve these objectives, and mentored if they fall short.

The OTO-Y3 during the early part of the year is closely supervised, but as the year goes on and the resident demonstrates satisfactory growth in judgment and skill, the individual is allowed more independent responsibility, with supervision readily available. This rotation, as with the other OTO-Y3 rotation, will provide this resident the opportunity to begin assuming the responsibilities required of a practicing otolaryngologist. This level of responsibility must be met by the conclusion of their training.

The OTO-Y3 resident must:

• Participate with members of a trauma team, each with his/her own specific responsibilities and capabilities. Describe the nature of injuries associated with head and neck trauma, including those affecting the C-spine or intracranial contents, and thorax.
• Apply the principals, techniques, and perioperative care of facial fractures, including those involving the ZMC, midface/LeForte, mandible, frontal region, orbit, naso-orbital-ethmoid complex, and nasal bone.
• Select and interpret appropriate radiographic evaluation for the above.
• Apply the principals, techniques, and perioperative care of soft tissue wound repair and scar revision.
• Describe and apply the principles of facial analysis.
• Diagnose problems expressed by the cosmetic surgery patient, select the appropriate techniques for management, and understand the surgical principals and postoperative care of these problems.
• Apply the principles, techniques, and perioperative care associated with cosmetic procedures including blepharoplasty, rhinoplasty, the various forms of rhytidectomy, injectable and alloplastic implants, hair restoration, and chemical denervation. Also, competently assist in these procedures.
• Describe and apply the principals, techniques, and care concerning skin resurfacing and the Facial Skin Care Program using Retin A®, glycolic acid, and skin care creams.
• Address the psychosocial needs of patients undergoing plastic and reconstructive surgery. Apply these principles in comprehensive patient management.
• By the conclusion of this rotation, the resident must have watched the series of Facial Plastic Surgery Videos recommended by the American Academy of Facial Plastic and Reconstructive Surgery (located in the Facial Plastic Surgery Center).

The Chief of the Division of Facial Plastic Surgery/Trauma at the MED is Dr. Phillip R. Langsdon. Dr. Francisco Vieira is Director of the MedPlex clinic. The MedPlex otolaryngology clinic sees facial trauma patients on Monday afternoons.

The OTO-Y1 resident under the guidance of Dr. Vieira treats patients at the MedPlex clinic in the head and neck oncology clinic Tuesday afternoon as well as a general otolaryngology clinic held Wednesday and Thursday afternoons.

The trauma/facial plastics resident sees patients after their head and neck trauma or in follow up after repair of their facial fractures or soft tissue injuries in the MedPlex ENT Trauma Clinic.

The OTO-Y3 resident is also first assist/surgeon on all facial cosmetic procedures at the Facial Plastic Surgery Clinic in Germantown. Residents are responsible for diagnosis, patient selection, planning, assisting/operating, and follow-up on all rhinoplasty, face lift, blepharoplasty, chin augmentation, otoplasty, skin resurfacing and reconstructive surgical procedure patients; as well as injectable filler, chemical denervation, pulsed light therapy, and other non-surgical facial enhancement procedure patients.

At the end of the rotation the resident should understand the technical aspects of all procedures, as well as the planning, patient selection, post op care, alternatives, risks, complications, limitations of all cosmetic procedures.

OTO-Y3 Resident (VAMC)

Clinics are held four times per week with approximately 5000 visits per year. Audiology and speech/swallowing services are integrated into the ENT Service. The clinics are staffed by Dr. Hodges (Clinic Director), Dr. Sebelik, and occasionally Dr. MacDonald.

The VA rotation is our most popular rotation because of its wonderful educational experience. The OTO-Y3 functions as chief resident on this rotation. Here they encounter the advanced cancer of the head and neck found in older VA patients. These extensive surgeries are an excellent opportunity for the OTO-Y3 to solidify their knowledge of Head and Neck Cancer management, anatomy, and to develop enhanced surgery skills.

The OTO-Y3 thrives in this closely supervised environment of one faculty to each resident. This is a highly anticipated rotation because they get to assist on major head and neck cases as well as improve their clinical and operative skills.

The resident educational goal is to expose the resident to the unique and diverse medical care problems and surgical problems encountered in a VA hospital so that they are familiar with the medical and surgical management of the disease.

To achieve this goal the specific educational objectives below were developed. The residents are evaluated by their ability to meet these objectives, and mentored if they fall short.

The OTO-Y3 resident must:

General

• Evaluate and manage sinus disease, including medical/allergic aspects and postoperative care. Competently perform maxillary antrostomy and anterior ethmoidectomy. Develop progressive experience in frontal and sphenoid surgery.
• Make accurate assessments in the diagnosis of sleep apnea. Order appropriate testing, and select the optimal management, including the role of CPAP. Perform sleep apnea surgery including UP3, genioglossus advancement, and hyoid suspension.
• Evaluate and manage laryngeal dysfunction related to aging.
• Accurately assess and manage audiovestibular functions related to aging, including the influence of systemic, neurologic, and cardiovascular disease.
• Develop an increasing level of independence, with faculty supervision, to prepare for the OTO-Y4 chief resident position.
• Demonstrate the ability to impart knowledge to junior residents and assist in their skill development.

Otology

• Diagnose and manage acute and chronic ear disease, including tympanoplasty, mastoidectomy.
• Expertly interpret audiometric and radiographic studies, including ABR, CT, and MRI. Apply these tests with appropriate indications.
• Workup and manage SNHL, particularly it affects the aging population. Select appropriate amplification.
• Workup and manage balance disorders, particularly it affects the aging population. Appreciate the multifactorial nature of this problem.

Head and Neck

• Accurately perform flexible and rigid endoscopy for workup and staging of malignancies.
• Appropriately select and interpret CT, MRI, and other radiographic evaluations of the head and neck.
• Provide comprehensive care in the management of head and neck oncology, including the role of organ preservation and quality of life issues, in association with medical oncologists, radiation oncologists, oral surgeons, prosthedontists, psychiatrists, and members of other surgical disciplines.
• Perform complex head and neck oncologic surgery such as neck dissection, laryngectomy, composite resection, parapharyngeal space, skull base, craniofacial resections, thyroidectomy, and salivary gland excision.
• Evaluate and manage thyroid and parathyroid disorders, and participate effectively with endocrinologist in the evaluation and treatment of patients with these disorders.
• Evaluate and manage the late treatment effects for this disease and provide effective follow-up care.

Trauma/Plastic/Reconstructive

• Assess the influence of the aging process on facial aesthetics and function, including rhytidosis, brow ptosis, eyelid disorders, and rhinophyma.
• Describe the management options and surgical techniques for these disorders.
• Evaluate and select reconstructive options after resection of head and neck neoplasms.
• Perform local and regional flap reconstruction, as well as skin grafting, full and split thickness.

The OTO –Y3 resident, during the early part of the year is closely supervised. As the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is allowed more independent responsibility, with supervision readily available. This rotation as with the other OTO Y3 rotation will prepare the resident to begin the responsibilities of an OTO-Y4 at the conclusion of the academic year.

The VA ENT service interacts actively with other services, specifically oral surgery, medical oncology, endocrinology and neurology in the management of our patients. We provide consultative services to all institutional departments.

All residents are required to attend all otolaryngology educational sessions during the VA rotation. Basic science topics are covered in the lecture series on an ongoing basis as well as extensively during the first year as part of the general surgery rotation between services.

OTO-Y3 Resident (Methodist)

In the years with two graduating chief residents, OTO-Y3 residents spend 2 months on the Methodist rotation following their 4 month Research rotation.

The OTO-Y3 resident must:

General

• Competently perform ESS including frontal, posterior ethmoid and sphenoid. Apply image guided surgery.
• Make accurate assessments in the diagnosis of sleep apnea. Order appropriate testing, and select the optimal management, including the role of CPAP. Perform sleep apnea surgery including UP3, genioglossus advancement, and hyoid suspension.
• Proficiently respond, evaluate, and manage acute and emergency problems of the head and neck, including airway obstruction, epistaxis, serious head and neck infections and surgical complications.
• Apply effective medical management for otologic and sinus disease, including the evaluation and management of allergic etiologies.
• Exhibit organization and management skills to manage an inpatient clinical service and outpatient practice, with faculty oversight.
• Supervise, with faculty oversight, the development of skills and knowledge by the junior resident.

Otology

• Diagnose and manage acute and chronic ear disease, including tympanoplasty, mastoidectomy.
• Expertly interpret audiometric and radiographic studies, including ABR, CT, and MRI. Apply these tests with appropriate indications.
• Workup and manage SNHL, including the selection of amplification.
• Perform accurate evaluation for balance disorders.

Head and Neck

• Accurately perform flexible and rigid endoscopy for workup and staging of malignancies.
• Expertly interpret CT, MRI, and other radiographic evaluations of the head and neck.
• Perform complex head and neck oncologic surgery such as neck dissection, laryngectomy, composite resection, parapharyngeal space, skull base, craniofacial resections, thyroidectomy, and salivary gland excision.
• Exhibit the ability to make clinical judgments regarding the management of oncologic problems, with active involvement in the multidisciplinary team including medical oncologists, radiation oncologists, oral surgeons, prosthedontists, psychiatrists, and members of other surgical disciplines.
• Evaluate and manage thyroid and parathyroid disorders, and participate effectively with endocrinologist in the evaluation and treatment of patients with these disorders.
• Interpret histologic data, including FNA, for squamous cell carcinoma, thyroid nodules, masses of the salivary glands, paraganglioma, and other tumors of the head and neck.

Trauma/Plastic/Reconstructive

• Assess and plan treatment for patients seeking cosmetic facial surgery including rhinoplasty, rhytidectomy, malar/mental augmentation and skin resurfacing.
• Describe the technical aspects of cosmetic surgical techniques and efficiently assist attending staff in these procedures.
• Evaluate and select reconstructive options after resection of head and neck neoplasms.
• Perform local and regional flap reconstruction, as well as skin grafting, full and split thickness.

The OTO –Y3 spends 2 months on this rotation following their research rotation and will assist and develop skills as they gain knowledge under moderate supervision. As the resident demonstrates satisfactory growth in judgment and skill they will be given more independent responsibility, with supervision readily available. The OTO-Y3 acquires more experience; increasing knowledge and perfecting surgical skills as well as increasing supervisory responsibility to prepare them for their role as an OTO Y4 the following year.

OTO Year 4 (PGY-5)

OTO-Y4 Residents (Methodist)

OTO-Y4 residents spend four months on this rotation. Methodist is an acute and chronic care facility. The institution is committed to the care of private and indigent patients of the Shelby County area, and thus maintains a large resident service for patients. Residents are exposed to a diverse population as found in a metropolitan private hospital. There is also a significant indigent patient population to augment their inner-city medical experience. An excellent general otolaryngology experience is received. One full time faculty and several volunteer clinical faculty work with the residents.

The Institution is committed to the care of private and indigent patients outside of the Shelby County area, and thus maintains a large resident service for patients from northern Mississippi, eastern Arkansas, western Tennessee and southern Missouri. Trainees of the Department of Otolaryngology-Head and Neck Surgery maintain an in-patient service, interact with private otolaryngologists, and run a daily ambulatory care clinic. Residents are exposed to adult patients with otologic problems, paranasal sinus disease, laryngology, head and neck surgery, etc. Among the clinical faculty, Dr. John M. Hodges, maintains a large clinical practice primarily directed towards general ENT, facial plastic and reconstructive surgery. Residents assist in the ambulatory surgery suite within Dr. Hodge's office on campus as part of the Methodist rotation. Dr. Christopher Hall also shares call and allows residents to assist him in a wide variety of surgical procedures.

The resident educational goal is to expose the resident to the diverse medical care problems found in a metropolitan private hospital so that they are familiar with the medical and surgical management of this population. There is also a significant indigent patient population to augment their inner-city medical experience at the MED and thus provides an opportunity to learn to provide excellent care in both the private and indigent communities. To meet this goal the specific educational objectives below were developed. The residents are evaluated by their ability to achieve those objectives, and mentored if they fall short.

The OTO-Y4 resident must:

General

• Competently perform ESS including frontal, posterior ethmoid and sphenoid. Apply image guided surgery.
• Make accurate assessments in the diagnosis of sleep apnea. Order appropriate testing, and select the optimal management, including the role of CPAP. Perform sleep apnea surgery including UP3, genioglossus advancement, and hyoid suspension.
• Proficiently respond, evaluate, and manage acute and emergency problems of the head and neck, including airway obstruction, epistaxis, serious head and neck infections and surgical complications.
• Apply effective medical management for otologic and sinus disease, including the evaluation and management of allergic etiologies.
• Exhibit organization and management skills to manage an inpatient clinical service and outpatient practice, with faculty oversight.
• Supervise, with faculty oversight, the development of skills and knowledge by the junior resident.

Otology

• Diagnose and manage acute and chronic ear disease, including tympanoplasty, mastoidectomy.
• Expertly interpret audiometric and radiographic studies, including ABR, CT, and MRI. Apply these tests with appropriate indications.
• Workup and manage SNHL, including the selection of amplification.
• Perform accurate evaluation for balance disorders.

Head and Neck

• Accurately perform flexible and rigid endoscopy for workup and staging of malignancies.
• Expertly interpret CT, MRI, and other radiographic evaluations of the head and neck.
• Perform complex head and neck oncologic surgery such as neck dissection, laryngectomy, composite resection, parapharyngeal space, skull base, craniofacial resections, thyroidectomy, and salivary gland excision.
• Exhibit the ability to make clinical judgments regarding the management of oncologic problems, with active involvement in the multidisciplinary team including medical oncologists, radiation oncologists, oral surgeons, prosthedontists, psychiatrists, and members of other surgical disciplines.
• Evaluate and manage thyroid and parathyroid disorders, and participate effectively with endocrinologist in the evaluation and treatment of patients with these disorders.
• Interpret histologic data, including FNA, for squamous cell carcinoma, thyroid nodules, masses of the salivary glands, paraganglioma, and other tumors of the head and neck.

Trauma/Plastic/Reconstructive

• Assess and plan treatment for patients seeking cosmetic facial surgery including rhinoplasty, rhytidectomy, malar/mental augmentation and skin resurfacing.
• Describe the technical aspects of cosmetic surgical techniques and efficiently assist attending staff in these procedures.
• Evaluate and select reconstructive options after resection of head and neck neoplasms.
• Perform local and regional flap reconstruction, as well as skin grafting, full and split thickness.

The OTO –Y4 during the early part of the year is closely supervised, but as the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is given more independent responsibility, with supervision readily available. This rotation as with the other OTO Y4 rotation will prepare the resident to begin the responsibilities of a practicing otolaryngologist at the conclusion of the academic year.

UT/Methodist Temporal Bone Lab is a fully equipped 10-station temporal bone lab located on the hospital grounds. Under the direction of Dr. Bruce MacDonald, a temporal bone course is held for residents twice each year. Additionally, all residents have access to the facility at any time, where frozen temporal bones are available 24/7.

Dr. Bruce MacDonald is the Medical Director of the Methodist Hearing and Balance Center and supervises the outpatient diagnosis and management of a large number of patients with auditory and vestibular disorders. He has successfully established an active cochlear implant program through this center.

OTO-Y4 Resident (MED/Baptist)

There are a large number of advanced cancer and some trauma case opportunities. Residents are staffed by two full time UT employees and a number of volunteer clinical faculty. This is a private community based institution with a large number of elective cases.

Baptist Memorial Hospital is the home base facility for Baptist Memorial Health Care Systems that administers several satellite hospitals throughout the mid-south. The institution hosts state-of-the-art diagnostic, surgical and rehabilitative treatment services and supports two FTE for post-graduate otolaryngology training. The hospital’s otolaryngology staff consists of full-time and clinical university faculty with a wide variety of cases, including head and neck oncology, skull base lesions and neurotologic surgery.

One OTO-Y4 residents rotates in the hospital for a four-month period under the supervision of Dr. Sandeep Samant. The general duties of this resident revolve around assisting the academic and private attending physicians in the care of their patients as well as caring for patients on the resident service. The attending staff is available in a nearby clinic to be called for consultation particularly to evaluate complex cases. The Baptist resident also attends the Monday oncology clinic. The resident rounds with various staff daily covering private and service patients. Consults are initially evaluated by the resident prior to presentation to attending staff. The resident is responsible for emergency room coverage for service patients and for patients of full time university faculty and for patients of private staff if specifically requested. The resident is responsible for the peri-operative care of all surgical patients under the direction of the attending physician.

The resident is the primary surgeon in all but the most sophisticated resident service cases. Cases regularly performed include classic and endoscopic sinus surgery, head and neck oncology procedures (laryngectomy, composite resection, parotidectomy, etc.) transcanal and transmastoid otologic surgery and perioral endoscopy with and without laser. As this is not a trauma referral center, the amount of otolaryngologic trauma is limited. No restrictions of privileges for resident thyroid surgery exist.

The resident works with world famous otology attending physicians on their private patients. The work level the resident performs is a function the of the resident’s competence in particular procedures. The resident does benefit from observing procedures he/she is not yet competent to perform, e.g. excision of glomus tumors, translabyrithinc in resection of acoustic neuromas, large anterior and middle skull base resections, hypophysectomy and cochlear implant.

The resident educational goal is to expose the resident of the diverse medical care problems found in a suburban private hospital so that they are familiar with the medical and surgical management of this population. The rotation augments their inner-city metropolitan private medical experience at Methodist. To meet this goal, the specific educational objectives below were developed. The residents are evaluated by their ability to achieve those objectives, and mentored if they fall short.

The OTO-Y4 (MED/Baptist) resident must:

General

• Effectively lead a team of otolaryngology residents managing patients with disorders of the head and neck. Increasing responsibility will be given at the discretion and supervision of the faculty.
• Proficiently coordinate daily care for inpatients, conducting the MedPlex clinic, managing the consultation service, and maintaining an organized operating room schedule at The Med in conjunction with the trauma resident and attending staff.
• Practice cost effective, medically sound, patient management.
• Competently perform ESS including frontal, posterior ethmoid, and sphenoid.
• Proficiently respond to acute and emergency problems of the head and neck, including airway obstruction, epistaxis, serious head and neck infections and surgical complications.
• Apply effective medical management for otologic and sinus disease.
• Supervise, with faculty oversight, the development of skills and knowledge by the junior resident.

Otology

• Diagnose and manage acute and chronic ear disease, including tympanoplasty, mastoidectomy.
• Expertly interpret audiometric and radiographic studies, including ABR, CT, and MRI. Apply these tests with appropriate indications.
• Workup and manage SNHL, including the selection of amplification.
• Evaluate and manage otosclerosis, including stapedectomy.

Head and Neck

• Accurately perform flexible and rigid endoscopy for workup and staging of malignancies.
• Expertly select and interpret CT, MRI, and other radiographic evaluations of the head and neck.
• Interpret histologic data, including FNA, for squamous cell carcinoma, thyroid nodules, and masses of the salivary glands.
• Perform complex head and neck oncologic surgery such as neck dissection, laryngectomy, composite resection, parapharyngeal space, skull base, craniofacial resections, thyroidectomy, and salivary gland excision.
• Make accurate clinical judgments regarding the management of oncologic problems, with active involvement in the multidisciplinary team including medical oncologists, radiation oncologists, oral surgeons, prosthodontists, psychiatrists, and members of other surgical disciplines.
• Diagnose and manage medical aspects of thyroid and parathyroid disorders, and participate effectively with endocrinologist in the care of these patients.
• Evaluate, manage, and provide follow-up care for late treatment effects in head and neck oncology patients.
• Interpret histologic data, including FNA, for squamous cell carcinoma, thyroid nodules, masses of the salivary glands, paraganglioma, and other tumors of the head and neck.

The OTO-Y4 during the early part of the year is closely supervised, but as the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is allowed more independent responsibility, with supervision readily available. This rotation as with the other OTO-Y4 rotation will prepare the resident to begin the responsibilities of a practicing otolaryngologist at the conclusion of the academic year.

OTO-Y4 Resident (Otology)

The OTO-Y4 (Otology) resident must:

Otology

• Diagnose and manage acute and chronic ear disease, including tympanoplasty, mastoidectomy.
• Expertly interpret audiometric and radiographic studies, including ABR, CT, and MRI. Apply these tests with appropriate indications.
• Workup and manage SNHL, including the selection of amplification.
• Perform accurate evaluation for balance disorders.
• Explain the pathophysiology of disease processes involving the skull base and apply the various surgical approaches for resecting such lesions, including CPA tumors/acoustic neuroma, paraganglioma, and tumors of EAC.
• Cooperate with other specialists including neurosurgery, neurotology, head and neck surgery, interventional radiology, radiation oncology, and reconstructive surgery in the comprehensive management of these lesions.
• Describe and apply the principles of facial nerve reanimation.
• Evaluate and manage chronic ear disease involving the middle ear and mastoid. This includes medical therapy, ventilation tubes, tympanoplasty, ossicular implants/ossiculoplasty, and mastoidectomy (simple, modified, radical).
• Evaluate and manage complications of otomastoiditis.
• Explain the pathophysiology, clinical findings, and management (amplification, medical, surgical) of otosclerosis, including the stapedectomy procedure.
• Workup and manage SNHL, including the selection of amplification.
• Perform accurate evaluation for balance disorders.
• Apply the appropriate selection criteria (for candidacy) and surgical technique for cochlear implantation.
• Participate with patients, families, and other specialists in rehabilitation.
• Manage otologic manifestations of congenital syndromes and malformations, such as cleft palate.
• Appropriately select and interpret audiologic data, including OAE and ABR.
• Appropriately select and interpret radiologic data, including CT and MRI.
• Show proficiency in responding to acute and emergency problems of the head and neck.
• Perform an accurate assessment of patients in a suburban ambulatory care setting and have complete knowledge of disease management.
• Competently perform general otolaryngology procedures with minimal guidance.

The OTO-Y4 during the early part of the year is closely supervised, but as the year goes on and the resident demonstrates satisfactory growth in judgment and skill the individual is allowed more independent responsibility, with supervision readily available. This rotation as with the other OTO-Y4 rotation will prepare the resident to begin the responsibilities of a practicing otolaryngologist at the conclusion of the academic year.