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Department of Otolaryngology

Residency Experience




Program Core

The Otolaryngology Residency is five years.  The first year is coordinated with the SUNY-Downstate Medical Center Departments of Surgery, Anesthesiology, Emergency Medicine and Neurosurgery, with whom we have had a productive working relationship for many years.  The excellent training provided by those departments is an integral part of the program designed to prepare the contemporary otolaryngologist-head and neck surgeon.  The following four years are spent almost exclusively in the Department of Otolaryngology. 

There are a total of 15 residents, with three residents accepted each year through the National Resident Matching Program.  The training program is designed to provide graduated responsibility, culminating in an intensive and tailored Chief Residency year.  There is full attending physician supervision in clinics, inpatient care and operating rooms in all affiliated hospitals.

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Residency Training - Progression of Resident Responsibilities

The resident training program consists of five years of progressive training in otolaryngology. The PGY-1 year in otolaryngology includes clinical and didactic activities that prepare residents to (a) assess, plan, and initiate treatment of adult and pediatric patients with surgical and/or medical problems, (b) care for patients of all ages with surgical and medical emergencies, multiple organ system trauma, soft tissue wounds, nervous system injuries and disease, and peripheral vascular and thoracic injuries, (c) care for critically-ill surgical and medical patients in the intensive care unit and emergency room settings, (d) participate in the pre-, intra-, and post-operative care of surgical patients, and (e) understand surgical anesthesia in hospital and ambulatory care settings, including anesthetic risks and the management of intra-operative anesthetic complications.

 

The training in this year is managed by the Departments Otolaryngology in coordination with the Departments of Surgery, Anesthesiology, Emergency Medicine, and Neurosurgery.  This year includes the following rotations, as mandated by the ACGME Program Requirements for Graduate Medical Education in Otolaryngology:

  • A minimum of 5 months of structured education in at least three of the following: general surgery, thoracic surgery, vascular surgery, pediatric surgery, plastic surgery, surgical oncology.
  • One month of structured education in each of the following four clinical areas: emergency medicine, critical care unit (intensive care unit, trauma unit or similar), anesthesia, neurological surgery.
  • An additional maximum of 3 months of otolaryngology head and neck surgery is optional, and any remaining months of the PGY-1 year may be taken on the clinical services listed above.

Rotations take place at UHB, KCHC, NY Methodist, and BVAMC as described below:

  • UHB rotations: otolaryngology, general surgery,  surgical oncology (encompassed in general surgery), anesthesia, cardiothoracic surgery, transplant surgery, vascular surgery (encompassed in transplant surgery)
  • KCHC rotations: otolaryngology, emergency medicine, critical care unit (SICU), neurosurgery, oncology
  • BVAMC rotation:  general surgery, vascular surgery (encompassed in general surgery)

 

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Typical Surgical Procedures Performed During RY-1

  • physical examination
  • ACLS (Advanced Cardiac Life Support)
  • ATLS (Advanced Trauma Life Support)
  • oxygen administration
  • bag-valve mask device usage
  • closed chest compression
  • oropharyngeal and nasopharyngeal airways
  • phlebotomy
  • peripheral intravenous lines
  • Foley catheter placement
  • arterial blood gas sampling
  • nasogastric tube placement
  • thoracentesis
  • central line placement
  • lumbar puncture
  • management of a lumbar drain
  • basic wound management
  • incision and drainage of simple abscesses, including peritonsillar
  • basic suturing of uncomplicated (non-facial, non-hand) lacerations
  • splinting of strains and sprains
  • flexible nasal and nasopharyngeal endoscopy
  • flexible laryngoscopy
  • fine needle aspiration in the neck
  • insertion and management of tracheotomy tubes
  • foreign body removal from the ear, nose and pharynx
  • anterior and posterior nasal packing

 

The PGY-2 year includes two two-months rotation at the New York Methodist Hospital and four two-month rotations at the University Hospital of Brooklyn/Kings County Hospital Center.  This PGY-2 year is directed to the development of clinical abilities, the taking of otolaryngological histories, performing physical examinations, and learning special techniques, leading to the identification and treatment of common conditions encountered in otolaryngology.  The resident participates in the outpatient clinical care of both pediatric and adult populations and also participates in specialty clinics, such as pediatric, otology, and head and neck oncology.

 

The Basic Science Program, during the first two months of the resident year, reinforces basic science application to the clinical practice of otolaryngology-head and neck surgery.  The lectures, in addition to temporal bone dissection and head and neck gross anatomy dissection, are provided by full-time and part-time faculty of otolaryngology and other medical school faculty.  An introduction to hearing and speech evaluation/therapy is provided by the audiology and speech faculty.

 

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Typical Surgical Procedures Performed During RY-2

  • Closed Reduction Nasal Fracture
  • Intranasal Antrotomy
  • Excision Preauricular Sinus
  • Turbinectomy
  • Tracheotomy
  • Myringotomy and Tube
  • Split Thickness Skin Graft
  • Full Thickness Skin Graft
  • Excision Skin Lesions, Primary Closure
  • Direct Laryngoscopy – Diagnostic
  • Direct Laryngoscopy and biopsy
  • Laryngoscopy with Excision
  • Reduction Facial Fractures
  • Mandibular Fracture Reduction – Closed
  • Adenoidectomy
  • Tonsillectomy
  • T & A

 

The PGY-3 year includes one one- month rotation at the outpatient office in Brooklyn Heights and the Bay Ridge ambulatory surgery center, one four-month rotation at the Brooklyn VA Medical Center, one four-month rotation at the University Hospital of Brooklyn/Kings County Hospital Center and three months of research.  Increasing responsibilities are reflected in performing inpatient consultations, and in teaching of medical students and residents of other programs.  Broad clinic patient responsibility and refinement of diagnostic and treatment skills are continued in the junior year.

 

Knowledge of work-up and differential diagnosis for complex diseases related to otolaryngology is required, such as acoustic neuroma, Ménière’s disease, diseases of the thyroid gland, allergy mediated disease, and unknown primary cancer of the head and neck.  Residents and gain experience in open reduction of facial fractures, removal of foreign bodies from the upper aerodigestive tract, pediatric endoscopy and laser procedures, tympanoplasty, excision of salivary glands, frontal and ethmoid sinus surgery, regional skin flaps, radical neck dissection, total laryngectomy, and cosmetic facial surgery.

 

 

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Typical Surgical Procedures Performed During RY – 3

  • Endoscopic Maxillary Antrostomy and Ethmoidectomy
  • Excision of Cysts (Globulomaxillary, Nasoalveolar)
  • Tympanoplasty –Type 1
  • Thyroglossal Duct Cyst Excision
  • Congenital Cyst Excision
  • Partial Neck Dissection
  • Submandibular Gland Excision
  • Lip Shave
  • Hemiglossectomy, simple
  • Excision other Nasopharyngeal Tumor
  • Lip Wedge Resection, 1o Closure
  • Local Resection Cancer Mouth
  • Incision & Drainage Neck Abscess
  • Cervical Lymph Node Biopsy
  • Repair Complex Facial Lacerations
  • Reduction Facial Fractures – Nasal
  • Reduction Facial Fractures – Malar
  • Reduction Facial Fractures – Orbital Blowout
  • Reduction Facial Fractures – Mandibular-open
  • Pedicle Flap Procedures – Local
  • Pedicle Flap Procedures – Regional
  • Endoscopic Sinus Surgery
  • Nasal Polypectomy
  • Caldwell Luc
  • Esophagoscopy – Diagnostic with Foreign Body Removal
  • Esophagoscopy – Diagnostic with Structure Dilation
  • Bronchoscopy – Diagnostic
  • Panendoscopy (Multiple Concurrent Endoscopic Procedures)

 

The PGY-4 year includes one four-month rotation at Maimonides Medical Center, one four-month rotation at the University Hospital of Brooklyn/Kings County Hospital Center, one one-month rotation in Research based at UHB and a three-month clinical rotation at the outpatient office in Brooklyn Heights and the Bay Ridge ambulatory surgery center.  The resident has substantial responsibility in administration and in teaching junior otolaryngology residents.  Also, at this stage, he or she develops knowledge and experience with various medical and surgical complications and their management.

 

The fourth-year otolaryngology resident is in charge of performing elective and emergency in-house consultations.  The resident also develops awareness of rehabilitation techniques and procedures pertaining to otolaryngology.  During this year, the resident gains more experience with parotidectomy, modified neck dissection, composite resection, sphenoethmoidectomy, mastoidectomy, stapedectomy, endolymphatic sac shunt, maxillectomy, rhinoplasty, rhytidectomy, blepharoplasty, otoplasty, correction of congenital deformities, facial nerve decompression, and removal of nasopharyngeal tumors.

 

The PGY-4 resident is expected to use the experience of this year to prepare for the Chief Resident experience.

 

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Typical Surgical Procedures Performed During RY-4

  • Canaloplasty
  • Tympanoplasty II-IV (without Mastoidectomy)
  • Modified Radical Mastoidectomy
  • Radical Mastoidectomy
  • Ossiculoplasty  (independent procedure)
  • Tympanoplasty with Mastoidectomy
  • Simple Mastoidectomy
  • Transnasal approach to the sella
  • Closure of Pharyngostome
  • Transantral Ligation of Vessels
  • Oroantral Fistula Repair
  • Choanal Atresia Repair
  • Uvulopalatopharyngoplasty
  • Excision of Simple Tumor of Nose
  • Cricopharyngeal Myotomy
  • Tissue Expander, placement and management
  • Lingual Tonsillectomy
  • Pedicle Flap Procedures-Myocutaneous
  • Lymphangioma excision
  • Parathyroidectomy
  • Thyrotomy (Laryngofissure)
  • Vertical Hemilaryngectomy
  • Supraglottic Laryngectomy
  • Pharyngeal Diverticulectomy
  • Modified Neck Dissection, primary
  • Excision with Flap Reconstruction
  • Lateral Rhinotomy
  • Superficial Parotidectomy
  • Composite Resection of Primary in Floor of Mouth, Alveolus, Tongue, Buccal Region,
  • Tonsillectomy, radical
  • Mandibular Resection (independent procedure)
  • Excision Pinna
  • Surgical Speech Fistula Creation
  • Arytenoidectomy, Arytenoidopexy
  • Thyroid Lobectomy
  • Subtotal Thyroidectomy
  • Total Thyroidectomy
  • Cervical Esophagostomy for Feeding
  • Major Vessel Ligation
  • Branchial Cleft Cyst Excision
  • Vocal Cord Injection
  • Laser Laryngoscopy
  • Bronchoscopy-Diagnostic with Foreign Body Removal
  • Bronchoscopy-Diagnostic with
  • Stricture Dilation
  • Dermabrasion
  • Brow Lift
  • Liposuction
  • Reduction Facial Fractures – Frontal
  • Otoplasty
  • Rhinoplasty
  • Mentoplasty
  • Blepharoplasty
  • Maxilla-Le Fort I
  • Maxilla – LeFort II
  • Rhytidectomy
  • Scar Revision
  • Frontoethmoidectomy
  • External Ethmoidectomy
  • Frontal Sinus Trephine
  • Endoscopic Sinus Surgery with sphenoidotomy and frontal sinusotomy

 

The PGY-5 year includes one four-month rotation at NY Methodist Hospital (administrative chief resident), one four-month rotation at the University Hospital of Brooklyn/Kings County Hospital Center and one four-month rotation at Brooklyn VA Medical Center.  The chief resident has administrative responsibility for all aspects of patient care. The resident gains wide exposure to the following concepts: chemotherapy and radiation therapy for treatment of patients with cancer of the head and neck, cancer immunology laryngotracheal reconstruction and skull base surgery.  The chief resident develops broad experience with the following surgical procedures: partial and total laryngectomy, tracheal resection and reconstruction, total parotidectomy, parathyroidectomy, temporal bone resection, mediastinal resection, craniofacial resection, orbital decompression, neck dissection and composite resection, complicated reconstructive problems of the head, neck and face, neuro-otology (including middle cranial fossa surgery, Meniere’s disease), cochlear implantation, skull base surgery, and major pediatric otolaryngological surgery. 

 

The chief resident participates actively in teaching medical students, paramedical personnel, and junior otolaryngology residents.  The chief resident also has major responsibility for assuring that the numerous consults received from other services are handled accurately and expeditiously and that attendings are fully informed and consulted on all patient care and administrative matters which occur at night and on the weekends.  Chief residents also are responsible for exploring clinical research projects and stimulating other members of the team to explore research opportunities.

 

All Chief Residents (and PGY-4 at Maimonides) are responsible for preparation of material for monthly M&M/PI/CQI conferences in the required format.  This includes presentation of data on patient volume (in-patient and out-patient), on-going issues in clinic and inpatient services, interaction with other services, NYPORTS, equipment and service needs, transfusions/rational, complications, morbidities, mortalities and changes in procedures mandated by the above.

Further information about the role of the Chief Resident is included in the Chief Resident Manual, which was first prepared by Boris Bentsianov, MD, former Chief Resident, and is updated annually.

 

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Typical Surgical Procedures Performed During RY-5

  • Total Parotidectomy with facial nerve preservation
  • Parapharyngeal Space Tumor Excision
  • Rhinectomy
  • Maxillectomy
  • Maxillectomy with Orbital Exenteration
  • Excision Tumor Ethmoid and Cribriform Plate
  • Temporal Bone Resection
  • Laryngopharyngectomy
  • Repair Laryngeal Fracture
  • Pharyngoesophagectomy
  • Tracheal Resection with Repair
  • Major Vessel Repair
  • Parotidectomy with Nerve Graft
  • Excision Angiofibroma
  • Transsternal Mediastinal Dissection
  • Scalene Node Biopsy
  • Facial Nerve Graft, Repair or Substitution
  • Microsurgical Free Flap
  • Skull Base Resection – Lateral
  • Excision of Paraganglioma of Neck and Skull Base
  • Laryngoplasty
  • Tracheoplasty
  • Fascial Sling Procedures
  • Pharyngeal Flap
  • Mediastinoscopy
  • Pharyngogastric Anastomosis (Gastric Pull-Up)
  • Skull Base Resection – Anterior
  • Skull Base Resection – Middle
  • Temporalis Muscle Transfer
  • Composite Graft
  • Osteoplastic Frontal Sinusectomy
  • Frontal Sinus Ablation
  • Radical Pan-Sinusectomy
  • Dacryocystorhinostomy
  • Cleft Lip Repair
  • Cleft Palate Repair
  • Reconstruction Congenital Aural Atresia
  • Reconstruction External Ear
  • Maxilla-LeFort III
  • Stapedectomy
  • Facial Nerve Decompression
  • Repair of Perilymphatic Fistula
  • Endolymphatic Sac Operation
  • Labyrinthectomy
  • Resection Cerebellopontine Angle Tumor


All residents participate in the numerous educational programs of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Triological Society, New York Head and Neck Society, and various New York Metropolitan residency programs. In addition, each resident is expected to have two active clinical research projects underway at any given time. The faculty provides supervision of these projects and encourages completion of manuscripts for publication and presentation at national and/or regional meetings.

 

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Training in Otolaryngology Allergy and Immunology

Training in otolaryngologic allergy and immunology includes the following:

  • Attendance at the Weill Cornell Allergy Resident Education (WeCare) course at the Weill Cornell Medical College
  • Combined Allergy-Rhinology Clinic at KCHC
  • Participation in programs of American Academy of Otolaryngic Allergy (AAOA) (residents are encouraged to join).
  • Series of lectures by the chairman on otolaryngologic aspects of AIDS.
  • Close clinical working relationship with KCHC and SUNY faculty in allergy and immunology.
  • Inclusion of discussion of allergic and immunologic aspects of otolaryngologic disease during routine conferences.
  • Use of AAO-HNS educational material in allergy/immunology including selected SIPacs, Monographs, and Home Study Courses.
  • Directed reading assignments on allergy/immunology topics.

 

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Training in Otology

 

 

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Training in Endocrinology

Training in endocrinology includes the following activites:

  • Extensive discussion on teaching rounds and in the operating rooms about the numerous patients who present with endocrine disorders or who require endocrine surgery.
  • Special Grand Rounds lectures and conferences on topics such as thyroid disease, parathyroid disease, diabetes, etc. These conferences involved colleagues from related clinical and basic science departments.
  • Numerous surgical cases are performed in conjunction with the Department of Neurosurgery which has a special interest in transsphenoidal hypophysectomy.
  • Use of AAO-HNS educational materials and selected reading in endocrinology.
  • Close working relationship with endocrinologists at all hospitals.

 

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Training in Neurology

Training in neurology includes the following activities:

  • Discussion of the neurologic aspects of various otolaryngologic disorders in the operating room, clinics, and teaching rounds.
  • Close working relationship with the Department of Neurosurgery with whom a Skull Base Surgical Center has been created at UHB and with whom we perform numerous surgical procedures.
  • Interactive research projects with Richard Kollmar, PhD in the Department of Cell Biology.

 

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Organization of Teaching Services and Clinics

The teaching service at each of the 4 sites (5 hospitals) is under the direction of a

            full-time staff member:

  • University Hospital of Brooklyn:                    Richard Rosenfeld      
  • Kings County Hospital Center:                     Matthew Hanson
  • Brooklyn VA Medical Center:                         Michael Weiss
  • Maimonides Medical Center:                        Michael Weiss
  • NY Methodist Hospital:                                   Krishnamurthi Sundaram

This physician is responsible for determining standards for the delivery of clinical care, defining and coordinating the intramural educational program, assuring that all institutional regulations are followed, monitoring resident progress, coordinating the activities of the attending staff and reporting promptly and accurately to the chairman on all departmental details.

 

The service chief recruits and supervises the attending staff, plans the intramural conference schedule, plans the operating room and clinic schedules and assures that there is a proper balance between service responsibilities and educational opportunities for the residents.  All surgery is performed under attending supervision and all clinics have attending coverage.  The chairman is present every week at the three major hospitals and makes periodic on-site visits to the other two hospitals.  He also holds carefully structured meetings with the service chiefs from each institution bimonthly to assess the progress of clinical and educational programs.

 

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Basic Science Education

The Chairman, Program Director, and Associate Program Director, in conjunction with the full-time staff, the Director of Communicative Disorders and the Director of Research, have planned a multifaceted program for basic science education which includes the following:

  • Introductory basic science conferences directed toward the first-,second- and third-year residents for 2 hours each week during July-September.
  • Special targeted seminars are held approximately quarterly to integrate basic science and clinical topics (such as thyroid function and thyroid surgery). 
  • Didactic instruction in biostatistics, epidemiology, and basic science research by Richard Rosenfeld, Nira Goldstein, and Richard Kollmar.
  • Monthly research conference that reviews current faculty and resident projects and monitors resident planning for the research rotation
  • Protected 4-month research rotation during the PGY-4 year in which the focus on basic science aspects or research experience are stressed.
  • Numerous interactive projects with colleagues in Anatomy, Physiology, and Cell Biology Departments at SUNY.
  • Use of basic science educational material prepared by AAO-HNS.

Attending rounds are conducted by the Socratic method.  Knowledge of basic sciences, including anatomy, physiology, biochemistry, microbiology and pathology are stressed in a way in which they can be related to direct patient care.

 

 

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Laboratory Facilities

A New York State accredited Research Laboratory is located at SUNY-Downstate and available to members of the Department of Otolaryngology. 

 

A seven-station temporal bone dissection laboratory is also located at the outpatient office in Brooklyn Heights. This state-of-the-art facility is the main laboratory for the department’s regular basic course in otologic surgery for the residents. The laboratory will move to SUNY-Downstate during this academic year.

 

A comprehensive animal laboratory is also located at SUNY-Downstate. The Brooklyn VA Medical Center also has an animal care facility and laboratory, which provides another potential site for research projects and funding.

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Scientific/Academic Computing Center

The Scientific/Academic Computing Center (S/Acc) located in the Basic Science Building at SUNY, aids students, staff, and faculty by offering formal courses, information, instruction and individual consultations.  The staff offers these consultations in a wide area of computer applications, including how to use the Center’s computers and other facilities, statistical analysis, data acquisition, analysis techniques, research methodology, and mathematical/analytical methods.

 

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Resident Rotations

Block Schedule for PGY1 Year

PGY1

KCHC, UHB

5-months: At least 3 of the following surgical rotations: general, vascular, oncology, thoracic, pediatrics and plastics.

5-months: 1 month in each of the following: vacation, anesthesia, critical care, emergency medicine, and neurosurgery

2-months: otolaryngology

 

 

 

 

Block Schedule for PGY2-5 Years

 

Block 1 (4 months)

Block 2 (4 months)

Block 3 (4months)

PGY2

NY Methodist

KCHC/UHB

KCHC/UHB

PGY3

UHB*/Research

Brooklyn VA Medical Center

KCHC/UHB

PGY4

UHB*/Research

Maimonides

KCHC/UHB

PGY5

NY Methodist Hospital

Brooklyn VA Medical Center

KCHC/UHB

KCHC, Kings County Hospital Center; NY Methodist Hospital

UHB, University Hospital of Brooklyn; VA, Veterans Administration

 

*Includes outpatient office in Brooklyn Heights and Bay Ridge ambulatory surgery center

 

Beginning 7/1/12, a 3-year transition period will take place to progressively move the research rotation from the PGY-4 year to the PGY-3 year.  Over each year, the PGY-4 resident will do one less month of the research rotation per year and one additional month at UHB and the PGY-3 will do one less month at UHB and one additional month of research.  The PGY years affected (current PGY-4s, PGY-3s and PGY-2s) will do 3 months of research with one additional month at UHB.  Beginning  7/1/15, the entire 4 month research rotation will be in the PGY-3 year and the PGY-4 residents will do 4 months at UHB.

 

 

Transition period schedule for the research rotation

 

Transition year 1 (7/1/12 – 6/30/13):                   1 mo.                                              3 mo.

              PGY-3                                                  Research                                        UHB     

              PGY-4                                                  UHB                                               Research

 

Transition year 2 (7/1/13-6/30/14):                       2 mo.                                              2 mo.

              PGY-3                                                   Research                                        UHB

              PGY-4                                                   UHB                                               Research

 

Transition year 3 (7/1/14-6/30/15)                       1 mo.                                               3 mo.

              PGY-3                                                  UHB                                                Research

              PGY-4                                                   Research                                         UHB     

 

Final schedule (7/1/15 – 6/30/16)                        4 mo.                                

              PGY-3                                                  Research

              PGY-4                                                  UHB

 

Resident Rotation Schedule Academic Year 2013-2014»


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Didactic Teaching Program

Grand Rounds

Grand Rounds are held every Thursday morning at the University Hospital of Brooklyn. All house staff, students, research fellows and faculty are required to attend. The first half hour is dedicated to the discussion of various residency related topics.  During the 7:00 to 8:00am hour, lectures are delivered by invited guests who are nationally known for their expertise and experience in a variety of topics.  In-house speakers and faculty as well as residents present information during the 8:00 to 9:00am hour. Also, journal club occurs from 8:00 to 9:00 on the second Thursday of each month and morbidity & mortality conference occurs during this time on the fourth Thursday. Biweekly Head and Neck Tumor Board is included in the schedule from 9:00 to 10:00. Alternating with the Comprehensive Otolaryngologic Curriculum Learning through Interactive Approach (COCLIA) course. Different aspects of basic sciences as related to the field of Otolaryngology-Head & Neck Surgery are presented and discussed from 7:00 to 9:00am during July and August.

 

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Morbidity and Mortality/Quality Improvement

Monthly departmental meetings are scheduled to discuss issues related to quality improvement, performance improvement and morbidity/mortality.  This important process involves all department members in an effort to improve individual, departmental, interdisciplinary and system activities in rendering quality patient care.  Focusing on the quality activities of all five affiliated hospitals provides a coherent departmental-wide program.  These conferences always include a systems-based practice approach, with identification of the roles of all members of the health-care team and identification of any institutional or system issues.

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Basic Science Lecture Series

During the summer, a 9-week basic science and communicative disorders course is given for 1st, 2nd and 3rd year residents, with senior resident attendance encouraged.  Held on Thursday mornings, the first hour is devoted to basic anatomic, physiologic, radiologic and pharmacologic aspects of otolaryngology - head and neck surgery.  The second hour is devoted to topics in clinical otolaryngology, audiology and speech and language pathology.

Resident Presentations

Twice a year each resident gives a formal presentation on a basic science or clinical subject at Grand Rounds.  The resident is expected to choose a faculty adviser to assist with topic selection, format determination and possible manuscript preparation.  The presentations may be a part of a research project and submission to local, regional and national meetings.

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Otology

Otology Conference - Kings County Hospital Center

The Otology Conference takes place on a weekly basis in the office of the Department of Otolaryngology.  The content of didactic and bedside teaching is based upon clinical material related to patients treated at Kings County Hospital and University Hospital of Brooklyn.  The resident presents the case, and the discussion is led and supervised by the attending physician.  An attempt is made to integrate the clinical material from the standpoint of diagnosis, treatment, and didactic teaching.  Operative cases are presented both before and following surgery.  The minutes of the conferences are recorded by the senior resident.  A similar conference takes place bi-weekly at the New York Methodist Hospital.

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Radiology and Pathology

Radiology and pathology conferences are held regularly every month within the context of the Grand Rounds conference.  Basic overview of imaging and pathology as well as interesting cases in the head and neck are presented.  Discussion and teaching is facilitated by experienced head and neck radiologists and pathologists.

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Combined Head and Neck Oncology

Twenty four times a year, the Departments of Oncology, Otolaryngology, Radiology, Radiation Therapy and Pathology meet to discuss recent head and neck cancer patients and selected topics in head and neck cancer.  A similar conference is held weekly at the Brooklyn Veterans Administration Medical Center.  A combined otolaryngology/radiation oncology/medical oncology Tumor Board is held at SUNY-UHB/KCHC once a month; all head and neck cancer cases are presented for treatment planning.

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Multidisciplinary Endocrine Surgery Conference

This Multidisciplinary Endocrine Surgery Conference takes place once every two months on a Thursday morning at the Long Island College Hospital site.  The conference is dedicated to diseases of the thyroid and parathyroid glands.   Our residents prepare cases for discussion by endrocrinologists, radiologists, pathologists and head and neck surgeons.

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Communicative Disorders

A set of in-service meetings have been established by the Division of Communicative Disorders for the residents of otolaryngology.   Topics covered include basic audiometry, immittance audiometry, evoked potentials, hearing loss, hearing aids, head and neck disorders, laryngectomy and rehabilitation and dysphagia.

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Temporal Bone Dissection Course

The department maintains a temporal bone microdissection laboratory at the LICH campus: residents attend a program over 2 weekends each year of their training.  Early course work stresses anatomy and embryology, followed by intensive dissections and surgical technique practice.  Dr. Neil Sperling and Dr. Matthew Hanson, along with other faculty members, guide the resident through this important and valuable educational program.  Temporal bones are also available for resident self-study and dissection.

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BVAH Otolaryngology Conference

Conferences involving the attending and the otolaryngology residents assigned to the BVAH take place twice a week (usually on Tuesday afternoon and Friday morning).  Consultations are reviewed, problem cases are presented, and surgical cases for the week are reviewed.  Patients with severe disabling tinnitus are seen by the attending every Friday morning and integrated into the conference.  Topics discussed at these conferences consist primarily of general otolaryngology, otology, nose and sinus surgery.

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BVAH Head and Neck Conference

Weekly (Thursday afternoon) Head and Neck Conferences are held at the BVAH.  The conference is attended by the residents and attendings on the otolaryngology team as well as the resident and attending staff of the Department of Surgery, Head and Neck Service.  There is a multidisciplinary group of physicians, radiologists, oral surgeons, oncologists and radio-therapists.  Patients are presented both before and following therapy.  The statistics of the Tumor Registry Board of the BVAH are reviewed specifically for cases of head and neck oncology.

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Special Evening Meetings

Four times a year, the New York Head and Neck Society hosts a Wednesday evening lecture series devoted to a particular issue.  Local, national and international authorities are invited to speak.  All residents are invited and sponsored by our department.

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Journal Club

On a monthly basis, the current literature is reviewed in a journal club format.  Review of the literature is important for keeping up-to-date with the ever-changing world of medicine.  The Journal Club format helps residents learn how to analyze research fundamentals and new material, allowing them to draw their own conclusions.  Reading the literature also helps create interest in specific research ideas and stimulates discussion and controversy.

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Home Study Course

The Home Study Course, offered by AAO-HNS, includes current reprints.  This course emphasizes both classic and current studies in otolaryngology-head and neck surgery.  The course consists of compendia published in four sections a year, beginning each September.  A self-assessment examination is provided after each section and scored for credit.  All residents participate in this course, with the registration fee paid by the Department of Otolaryngology at SUNY Downstate.

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In-Training Examination

Weekly conferences involving all members of the residency staff are held from January to April of each year up to and including the week before the American Board of Otolaryngology In-Training Examination for Residents.  The conference takes place in the library located at the Atlantic Ave Office, and is attended by available members of the residency staff.  Supervision is provided by an attending who is present at the request of the resident staff and is available for consultation.  Topics from past examinations are reviewed to allow more comprehensive coverage of all aspects of the specialty of Otolaryngology - Head and Neck Surgery.  The library setting allows for immediate availability of reference material as well as audio/visual equipment.

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Mock Oral Board Examinations

Approximately 4 times annually the department will conduct a mock oral board examination session as part of the grand rounds schedule.

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COCLIA Review Course

Comprehensive Otolaryngologic Curriculum Learning through Interactive Approach (COCLIA) is a teaching tool to help residents learn otolaryngology-head and neck surgery.  This study guide provides discussion questions for over 100 major otolaryngology topics. Residents meet monthly to review the questions and learn from each other.

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Educational Objectives

Each resident is provided with a copy of the AAO-HNS monograph, "Educational Objectives for Residents in Otolaryngology-Head and Neck Surgery", at the beginning of their residency. An outline of the Education Objectives is in the Addendum at the end of this manual.

Suggested Readings

Specific reading requirements by training year are given under the “Medical Knowledge” competency sections in the “Goals and Objectives” document.  In addition, it is expected that residents implement a systematic reading schedule to prepare for the annual Otolaryngology Training Examination each spring.  The goal of the reading schedule should be to cover all material in a general otolaryngology textbook (e.g. Bailey’s) at least once annually, even if only superficially.  More in-depth and focused reading should occur progressively as the resident advances in training.

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Research Expectations

All residents in the PGY-2 through PGY-5 years are expected to present a research project at the annual Frank E. Lucente Resident and Alumni Research Day in June.

Research projects may consist of (a) case series and chart reviews, (b) systematic reviews or meta-analyses of the literature, (c) planned observational research, (d) survey research or projects, or (e) experimental research (basic science or clinical trials).

A resident should be able to identify an area of study and specific questions to be addressed.  The resident should be able to develop an investigative plan in the form of a research protocol, which will address the questions to be answered (i.e. retrospective vs. prospective) and explain their limitations.  One should be able to design and implement a study.  One should also be able to critique study design, methodology, statistical analysis and interpretations in both their own work as well as journal publications.

Residents are expected to work independently.  Faculty members are available as advisors to provide guidance and direction.

 

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Designated Research Time

Four months of protected research time is available to all residents during the PGY-4 year of otolaryngology training.  Beginning 7/1/12, a 3-year transition period will take place to progressively move the research rotation from the PGY-4 year to the PGY-3 year.

Research is part of the ACGME core competency on practice-based learning and improvement (PBLI).  Please refer to the “Goals and Objectives” document for a description of research expectations in the PGY-4 year under the PBLI subheading.

Research must be done at the University Hospital of Brooklyn or Brooklyn VA.  Research may be basic science or clinical.  Work may be performed in any department as long as the work is done in one of the approved institutions and a member of the full time Otolaryngology faculty must be one of the research advisors.

Residents are encouraged to develop projects that can be completed during the allotted research time.  Cost factors are also important in determining whether a protocol is approved.

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Undesignated Research Time

All residents are expected to take advantage of the large clinical volume available to them.  A clinical issue to study prospectively should be identified during the first three years of training.  With the assistance of an otolaryngology faculty member, a protocol is then written and submitted to the Otolaryngology research committee for approval.  Subsequent approval by the institution research review board may also be required.  After approval of a protocol, the study should be performed without interfering with other clinical responsibilities.

A retrospective study using the clinical material available at any or all affiliated institutions should also be performed during the regular clinical assignments.  Again, a protocol should be written and approved by the research committee prior to incurring any expense.

 

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