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Department of OtolaryngologyResidency Experience
Program CoreThe Otolaryngology Residency is currently five years long. The first year is primarily surgical, with rotations in surgery, anesthesiology, neurosurgery, critical care and emergency medicine at SUNY Downstate and affiliated hospitals. The excellent training provided by the Department of Surgery is an integral part of the program designed to prepare the contemporary otolaryngologist-head and neck surgeon. The remaining four years are spent solely in Otolaryngology. There are a total of fifteen residents, with three residents accepted each year. 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 and operating rooms in all affiliated hospitals. Residency Training - Progression of Resident ResponsibilitiesThe resident training program consists of five years of progressive training in otolaryngology. The first year of training is to be completed in conjunction with SUNY Downstate’s general surgery program. Surgery residents rotate through University Hospital of Brooklyn, Kings County Hospital Center, Brooklyn VA Hospital, Long Island College Hospital, and Lutheran medicine Center. During this year, the residents are expected to gain sufficient experience in basic understanding of pre and postoperative patient care, management of acute trauma of the head, chest, and abdomen, soft tissue surgical techniques, diagnosis and treatment of pulmonary and cardiac emergencies, management of fluid and electrolyte balance, and in understanding of basic problems in anesthesia, neurosurgery, vascular surgery, thoracic surgery, plastic surgery, critical care, emergency medicine, and general surgery. Two months are spent in otolaryngology at UHB-KCHC. Residents are trained in the head and neck examination, otolaryngology history taking, special techniques and identification/treatment of common otolaryngologic diseases. Exposure and experience with the following otolaryngologic procedures is expected from the first year residents: tonsillectomy, adenoidectomy, tracheotomy, incision and drainage or peritonsillar abscesses, adult nasal and laryngeal endoscopy, repair of complex facial lacerations, and removal of foreign bodies (nose, ear, pharynx). The first year resident also gains experience by assisting on more advanced cases. He or she begins to evaluate consults from other services and reviews findings and proposed plans with the senior residents and supervising attendings. Typical Surgical Procedures Performed During RY-1
The second year of otolaryngology 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 Basic Science Program, during the first three months of residency training, serves as an introduction to the application of basic sciences for the clinical practice of otolaryngology-head and neck surgery. The lectures, 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. The clinical rotation includes eight months at LICH and four months at UHB-KCHC. The resident participates in the outpatient clinical activities with both pediatric and adult populations. An introduction to hearing and speech evaluation/therapy is provided by the speech and audiology faculty. The resident also participates in specialty clinics, such as pediatric, otology and allergy. Exposure and experience with the following surgical procedures is required from second year otolaryngology residents: excision of neck masses, tonsillectomy and adenoidectomy, septoplasty, myringotomy, myringoplasty, closed reduction of facial fractures, adult diagnostic endoscopy, surgery of the maxillary sinus, tracheostomy, skin grafts, and nasal polypectomy. By assisting on more advanced cases, the second-year resident gains experience in the planning of procedures and in anticipating postoperative problems. Residents in this year also handle consultations from other services and review their findings and proposed plan with senior staff members. The resident is given full supervision by the attendings and senior residents assigned to the service. Typical Surgical Procedures Performed During RY-2
The third year of otolaryngology residency training expands upon the plan outlined above. Increasing responsibilities are reflected in the performance of inpatient consultation, 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 (acoustic neuroma, Meniere’s disease, diseases of the thyroid gland, allergy mediated disease, and unknown primary cancer of the head and neck). The resident also gains experience in the treatment of complex postoperative problems. The hospital rotation includes four months at the Brooklyn V.A. Medical Center, four months at UHB-KCHC and four months at LICH focusing on Otology and Communicative Disorders. During this year, the resident develops exposure and experience with the following surgical procedures: open reduction of facial fractures, removal of foreign bodies from the upper aero-digestive tract, pediatric endoscopy, endoscopic laser procedures, tympanoplasty, excision of salivary glands, frontal and ethmoid sinus surgery, delay and rotation of regional skin flaps, radical neck dissection, total laryngectomy, and portions of the following: blepharoplasty, rhinoplasty, otoplasty, and liposuction. The third year resident at LICH has specific assignments in the Communicative Disorders Division in which diagnostic testing and treatment planning are emphasized. Typical Surgical Procedures Performed During RY – 3
The Fourth year otolaryngology training is divided into three four-month rotations at UHB-KCHC, Maimonides Medical Center, and LICH in a protected research rotation. The resident participates in the Continuing Medical Education Course offered by AAO-HNS. The resident has tremendous responsibility in administration and 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 reviewing 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 the following surgical procedures: parotidectomy with facial nerve dissection, 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. A major facet of the fourth year rotation involves working in the office of Dr. Mark Erlich, an otolaryngologist-facial plastic surgeon who performs a large amount of cosmetic surgery in his Manhattan private practice office. The resident spends one full day with Dr. Erlich during most weeks. This same resident along with attending staff closely supervises the work of the first and second year residents. This serves as an introduction to the Chief Resident experience. Typical Surgical Procedures Performed During RY-4
The fifth year of otolaryngology training (the chief resident) is one of total responsibility. This involves administrative duties pertaining to scheduling, residency training, teaching responsibility (including medical students), and conclusion of research projects. The highlight of this final year is total exposure to surgical experience to provide adequate training for certification in the specialty of otolaryngology-head and neck surgery. The resident rotates every four months through LICH, the VA and UHB-KCHC. 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 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), 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 kept fully informed 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. Typical Surgical Procedures Performed During RY-5
All residents participate in the numerous educational programs of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). 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 ImmunologyTraining in otolaryngologic allergy and immunology includes the following:
Training in OtologyTraining in otology is very broad-based and comprehensive, including the following activities:
Training in EndocrinologyTraining in endocrinology includes the following activities:
Training in NeurologyTraining in neurology includes the following activities:
The training of residents in these targeted areas (allergy, immunology, otology, endocrinology and neurology) is an important part of their overall training program. Each resident has an active role in determining his/her own program, participating in the departmental program, monitoring personal progress and making recommendations for improving the overall training program. Responsibilities increase as the resident progresses through the 5-year program. Organization of Teaching Services and ClinicsThe 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 attendings staff and reporting promptly and accurately to the chairman on all departmental details. The service chief recruits and supervises the attendings 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 at least once a month to assess the progress of clinical and educational programs. Basic Science EducationThe Chairman and Director of Resident training, 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:
Most years at least one resident attends the Association for Research in Otolaryngology (ARO) meeting. Importantly, attending rounds are conducted by the Socratic method and 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. Laboratory FacilitiesA New York State accredited Research Laboratory is located at SUNY Downstate and is used actively by members of the Department of Otolaryngology. Current resident research projects include laryngeal and tracheal reconstruction techniques, microvascular anastomoses and experimental laser surgery. A eight-station temporal bone dissection laboratory is also located at Long Island College Hospital. This state-of-the-art facility is the main laboratory for the department’s regular six-month basic course in otologic surgery for the residents. A comprehensive animal laboratory is also located at SUNY Downstate. In addition, our department maintains two basic research laboratories at the University. There is a two-station temporal bone laboratory located at Kings County Hospital. This is intended to be a supplementary laboratory to be used by the residents rotating through UHB. The Brooklyn VA Medical Center also has an animal care facility and laboratory, and provides another potential site for research projects and funding. Scientific/Academic Computing CenterThe Scientific/Academic Computing Center (S/Acc) located in the Basic Science Building at SUNY, aids students, staff, and faculty in their scientific computing by offering formal courses, information, instructions 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. Resident RotationsDuring the five years of otolaryngology training residents rotate through the following hospitals:
Didactic Teaching ProgramGrand RoundsGrand Rounds are held every Thursday at Long Island College Hospital. All house staff, students, research fellows and faculty are required to attend. Basic science topics are presented during the first part of the program. The second part is devoted to clinical topics. There are frequent guest lecturers from the New York Metropolitan area as well as from programs throughout the United States and abroad. All conferences provide ample opportunity for active participation by residents, students and attending staff members. Morbidity and Mortality/Quality ImprovementMonthly 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. Resident PresentationsTwice a year each resident presents his or her clinical research at Grand Rounds. The resident is expected to choose a faculty adviser to assist with topic selection, format determination and manuscript preparation. The presentations are generally considered for submission to local, regional and national meetings. OtologyOtology-Radiology Conference 1st Tuesday of each month at LICH: Otologic case review and temporal bone imaging conference. This is a thorough review of an otologic case lead by a resident presentation. Clinical data with emphasis on the imaging studies is reviewed. Management options are discussed in detail. Cochlear Implant Conference 3rd Tuesday of each month at LICH: Cochlear Implant Team meeting. This is a multidisciplinary meeting involving audiologists, speech pathologists social workers and otolaryngologists to discuss current issues of cochlear implantation. Individual cases are reviewed in detail to determine candidacy. Progress reports and outcomes of prior implants are discussed. Otology Conference - Kings County Hospital Center The Otology Conference takes place on a weekly basis in the office of the Department of Otolaryngology. Medical student participation is required. Didactic and bedside teaching is based upon current and past clinical material presented as inpatient or outpatient clinical problems. 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. Problems within the hospital or the OPD service are presented and discussed, and operative cases are presented both before and following surgery. The minutes of the conferences are recorded by the senior resident.
Radiology and PathologyRadiology and pathology conferences are held regularly every month within the context of the Grand Rounds conference. Difficult as well as interesting cases are presented. Discussions and teaching is motivated by experienced head and neck radiologists and pathologists. Combined Head and Neck OncologyTwenty four times a year, the Departments of Oncology, Otolaryngology, Radiology, Radiation Therapy and Pathology meet at LICH 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 conference on head and neck cancer is held at SUNY-HSCB/KCHC once a month; all head and neck cancer cases are presented and discussed. In-Service Review CourseWeekly 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 National In-Service Examination for Residency Training and Otolaryngology. The conference takes place in the LICH library, and is attended by all members of the residency staff at every level of residency training. Supervision is by an attending who is present at the request of the resident staff and is available for consultation. Examination questions of the past are reviewed, and assignments are distributed among the residents 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 storage of conference audio/visual material. Communicative DisordersA 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 CourseThe department maintains a state-of-the-art 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. Journal ClubOn 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 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 CourseThe 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 four sections a year and begins 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. Patient of the MonthA patient-of-the-month program offered by the AAO-HNS consists of clinical simulation exercises designed to promote interest in new developments and a constant awareness of accepted methods of diagnosis and treatment. Educational ObjectivesEach 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 ReadingsEach resident should purchase the following:
ExpectationsAll residents are expected to complete and publish at least one clinical chart review, one retrospective study, one prospective clinical study, and one research project and preferably more. 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. Protected Research TimeFour months of protected research time is available to all residents during the second year of otolaryngology training. Each resident must submit a research proposal to the ENT research committee a minimum of four weeks in advance of the scheduled research time. Only those residents with approved protocols will be granted protected research time. Research must be done at SUNY-Downstate, LICH, 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. Unprotected Research TimeAll 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 two 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. |