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Department of Otolaryngology
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:
Rotations take place at UHB, KCHC, and BVAMC as described below:
Typical Surgical Procedures Performed During PGY-1
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.
Typical Surgical Procedures Performed During PGY-2
The PGY-3 year includes 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 four 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.
Typical Surgical Procedures Performed During PGY – 3
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 a four-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.
Typical Surgical Procedures Performed During PGY-4
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.
Typical Surgical Procedures Performed During PGY-5
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.
Training in Otolaryngology Allergy and Immunology
Training in otolaryngologic allergy and immunology includes the following:
Training in Otology
Training in Endocrinology
Training in endocrinology includes the following activites:
Training in Neurology
Training in neurology includes the following activities:
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:
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.
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:
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.
A New York State accredited Research Laboratory is located at SUNY-Downstate and available to members of the Department of Otolaryngology.
A new temporal bone dissection laboratory that will serve as a state-of-the-art facility for the department’s regular basic course in otologic surgery for the residents will be opening up at SUNY-Downstate in the next 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.
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.
Block Schedule for PGY1 Year
Block Schedule for PGY2-5 Years
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
Didactic Teaching Program
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.
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.
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.
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.
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.
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.
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.
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.
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.
Temporal Bone Dissection Course
During each year of training, residents attend a 3 day temporal bone course. Early course work stress anatomy and embryology, followed by intensive dissections and surgical technique practice. Dr. Matthew Hanson, Dr. Neil Sperling, and Dr. Michal Preis 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.
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.
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.
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. The residents also attend the yearly New York City Pediatric Airway Course.
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.
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.
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 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.
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.
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.
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.
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.
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. A research template must be completed six months prior to the start of the research rotation for review by the faculty mentor and research faculty.
Designated Research Time
Four months of protected research time is available to all residents during the PGY-3 year of otolaryngology training. 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-3 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.
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.