2011‐2012EDUCATIONALGOALS&OBJECTIVESBYROTATION

GENERALSURGERY

alsPGY1:SURGICALINTENSIVECAREUNIT(SICU)Go 1. Developtheabilitytorapidlyevaluate,diagnose,stabilize,and

dispositioncriticallyillpatients.2. Learnrespiratory,cardiovascular,renalandneurologicphysiology

andthepathophysiologyoftrauma,toxins,shock,sepsis,cardiac failure,andrespiratoryfailurethataffectcriticallyillpatients.

3. Learntheprinciplesofmedicalinstrumentationandhemodynamic monitoringandbeabletoutilizetheminthecareofcriticallyill patients.

4. Learntheindicationsanddevelopthetechnicalskillsneededtoill performdiagnosticandtherapeuticinterventionsincritically

patients.5. Learntherationaluseoflaboratory,radiographicandother

est. diagnostictestsinthemanagementofcriticallyillpatients.

6. Understandtheetiologiesandpathophysiologyofcardiacarr7. Learntorecognizethedysrhythmiasassociatedwithcardiac

arrestandtheirtreatment.8. LearntheAHAandACSadvancedlifesupportrecommendations

e anddevelopskillintheperformanceofstandardresuscitativ procedures.

. apyandtheroutesandcardiac

9 Learntheprinciplesofpharmacother dosagesofdrugsrecommendedduringresuscitations,

arrestandprolongedintensivecare.ithholdingandterminating10. Learntheindicationsforw

resuscitation.11. Thisisa1monthrotation.LearningObjectives:CoreCompetenciesProfessionalism:

iples1. Demonstrateanunderstandingoftheethicalandlegalprinc applicabletothecareofcriticallyillpatients.2. Demonstrateunderstandingof“Donotresuscitate”orders, advancedirectives,livingwills.

Int ersonal&CommunicationSkills:tofpatientsinacompleteandresponsiblemanner.

erp1. Presentsign‐ou

.MedicalKnowledge:1. Demonstrateappropriateprioritizationofdiagnosticandtherapeuticinterventionsincriticallypatients2. Demonstrateabilitytodiagnoseandtreatshock,sepsis,fluidandelectrolyteabnormalities,andcardiac

failure.3. Demonstrateabilitytomanagetheairwayduringcardiacarrest,includingmouth‐to‐mouthventilation,

nofthebag‐valve‐maskventilation,endotrachealintubation,cricothyroidotomy,andrecognitioobstructedairway.

nalclosedchestcardiopulmonaryresuscitation.4. Demonstrateabilitytoperformexter

actir ce‐BasedLearning&Improvement:

withotherhospitalswithregardtoacceptanceordenialofpatientsfortransfer.P1. Interacttie

Pa ntCare:1. Demonstrateabilitytorapidlyperformhistoryandphysicalexamsincriticallyillpatients.

ral2. Demonstratetheabilitytoperformthefollowingprocedures:oralendotrachealintubation,centintravenousplacement,andFoleycatheterization.

3. DemonstratetheabilitytouseandinterpretdatafromECGmonitors,arterialbloodgases,pulseoximetry,endtidalCO2monitorsandrespirators.

4. Describetheindicationsandcontraindicationsofpharmacologicinterventionsforshock,cardiacfailure, icfailure,renalfailure,andneurologicdysrhythmias,sepsis,trauma,toxins,respiratoryfailure,hepatillnesses.

. Demonstratetheabilitytomanageapatientonaventilator.priatejudgmentinthemanagementofcriticallyillpatients.

56. Demonstrateappro

stemy s‐BasedPractice:. DemonstrateanunderstandingoftheappropriateuseofconsultantsincriticallyillpatientsS1PGY1:NEUROSURGERYGoalsUnderstandtherelationshipbetweentheskullbaseandthebrain,andtoappreciateneurosurgicalemergenciesandhowtotreatthem.Asmanystructuresintheskullbase,suchasthesinusesandthetemporalone,arepotentialparameningealfociforinfectionsortrauma,theresidentwillunderstandtheimportanceof

usestothebrain.Thisisa1monthrotation.bdiseaseprocessesinthenose,earsandsinLearningObjectives:CoreCompetenciesProfessionalism:

tfulpatientcare,familyinteractions,and1. Todemonstratecompassionandintegritythroughrespec communicationwithotherhealthcareproviders.2. Tounderstandwhenexpertmedicaladviceisnecessary.. Toobtainexpertmedical,nursing,orotheropinionswhenlimitsofknowledge,experience,andtraining

arereached.3

Interpersonal&CommunicationSkills:1. Topresentclinicalinformationonworkroundsclearlyandconcisely.2. Towriteprogressnoteswithsufficientdetailsothatpatients’condition,statusandcareplansareclear.

edical3. Toworkeffectivelywithattendingstaff,housestaffcolleaguesinsurgeryandpediatricservices,m students,nurses,ancillarypersonnel,pre‐hospitalpersonnel.. Tokeepseniorresidentsandattendingstaffinformed,particularlywith“problem”cases,unstable

angesin‐patientconditionandcareplan.4 patients,andchMedicalKnowledge:. Toexpandfundofknowledgefromtextbooks,journals,andelectronicmedia,especiallyregarding

uma,andCSFleaks.1 neurosurgicalemergencies,headtra

ctiPra ce‐BasedLearning&Improvement:1. Toevaluatepatientscriticallywiththegoalofcomingupwithaworkingdiagnosisandtreatmentplan. ent2. Tounderstandthemedical,surgical,andscientificbasesofapatient’sconditionandhisorhertreatm

plan.. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,work‐up,orhospitalcourse

cessary.3 whenne

ienPat tCare:..1 Toknowup‐to‐presentdetailsofallassignedpatients.2 Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including: a. Learningtoobtainclinicalinformationfromchildrenandparents.

rtments(e.g.,radiology,laboratory, b. Obtainingrelevantinformationfromnursesandhospitaldepa andhospitalinformationsystems).

gpediatricians,hospitals.. c. Obtaininginformationfromreferrin3 Tolearntheprinciplesofpreandpostoperativemanagement,including:

ioticdosingandpharmacology. a. Fluidandelectrolytemanagement.

icalmanagement,includingpainandsedation,antib b. Pharmacolog c. Recognitionandmanagementofrespiratorydistressandshock. d. Woundcare.

ludingreferralsandresourcesforsocialwork, e. Follow‐upandoutpatientmanagement,incedicine.

. rehabilitationandphysicalm4 Toperformbasicclinicalprocedures,including:

incisions.ectedwounds.

a. Primaryclosureof b. Managementofopenandinf

c. Lumbarpuncture.neplacement.

d. IntravenousliSystems‐BasedPractice:

tontheprimaryservice.1. Toeffectivelytransfercarewhendutyhoursarecompleted.. areresponsibilitiesofpatientswhoareno. tionalebehindthem,including:2 Toresponsiblyaccepttheon‐callc3 Toapplystandardizedcareplans,andthera

ssure. a. Admissionforheadtrauma. b. Managementofintracranialpre c. Clearanceofthecervicalspine.

4. Toparticipateincareconferencesonassignedpatients.. governmentalagencies,healthcare5 Towritenoteswithsufficientdetailtosatisfytherequirementsof

careplans. payerorganizations,including:

a. Admissionhistories,physicalexaminations,andb. Dailyprogressnotes,anddischargesummaries.

PGY1:GENERALANDPEDIATRICSURGERYClinicalMission/GoalsTheclinicalmissionoftheDivisionofPediatricSurgeryattheUniversityofNorthCarolinaatChapelHillistoprovidethehighestlevelofcareininfants,childrenandadolescentswithcongenitalandacquiredconditionshatrequiresurgery.Ourgoalsincludecaringforcomplexcongenitalmalformations,advancedsurgical

forcomplicatedcasesinamultidisciplinaryfashion.tconditionsandcaringEducationalMissionObjectivesreflectteamwork;i.e.,theskillsandresponsibilitiesblendsothattheycomplementcontributionsromothermembersofthephysicianteamandrecognizetheinputfromnursingandotheralliedhealthfprofessionals.LearningObjectives:CoreCompetenciesProfessionalism:

tfulpatientcare,familyinteractions,and1. Todemonstratecompassionandintegritythroughrespec communicationwithotherhealthcareproviders.2. Tounderstandwhenexpertmedicaladviceisnecessary.. Toobtainexpertmedical,nursing,orotheropinionswhenlimitsofknowledge,experience,andtraining3 arereached.Interpersonal&CommunicationSkills:1. Toevaluatepatientscriticallywiththegoalofcomingupwithaworkingdiagnosisandtreatmentplan.

ent2. Tounderstandthemedical,surgical,andscientificbasesofapatient’sconditionandhisorhertreatm plan.

rdingapatient’sstatus,work‐up,orhospitalcourse3. Toobtainconsultationsandotheropinionsregawhennecessary.

nteachingthemedicalstudents.4. ToparticipateiMedicalKnowledge:1. Toexpandthefundofknowledgefromtextbooks,journals,andelectronicmedia,especiallyinregardsto

sis pediatricsurgeryconditions,includingdiaphragmatichernia,Hirschsprung’sdisease,pyloricsteno andcloacalabnormalities.. Tocriticallyevaluatetheliteraturebaseduponmethodologyandstatisticaltechniques,asurveyof

ddiscussionswithattendingstaffandotherexperts.2 relatedarticles,andresident‐initiate

ctiPra ce‐BasedLearning&Improvement:1. Topresentclinicalinformationonworkroundsclearlyandconcisely.2. Towriteprogressnoteswithsufficientdetailsothatpatients’condition,statusandcareplansareclear.

3. Toworkeffectivelywithattendingstaff,housestaffcolleaguesinsurgeryandpediatricservices,me students,nurses,ancillarypersonnel,pre‐hospitalpersonnel.

dical

4. Tokeepseniorresidentsandattendingstaffinformed,particularlywith“problem”cases,unstable

patients,andchangesin‐patientconditionandcareplan.. Tofosterteamworkandaworkenvironmentbaseduponcommunication,respect,trustandhonesty.

rasocialenvironmentbasedupontoleranceforotheropinions, backgrounds,andcultures.56. Tofoste

ienPat tCare:..1 Toknowdetailsofallassignedpatients.2 Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including: a. Learningtoobtainclinicalinformationfromchildrenandparents

rtments(e.g.,radiology,laboratory, b. Obtainingrelevantinformationfromnursesandhospitaldepa andhospitalinformationsystems)

gpediatricians,hospitals.. c. Obtaininginformationfromreferrin3 Tolearntheprinciplesofpreandpostoperativemanagement,including:

ioticdosingandpharmacology. a. Fluidandelectrolytemanagement.

icalmanagement,includingpainandsedation,antib b. Pharmacolog c. Recognitionandmanagementofrespiratorydistressandshock. d. Woundcare.

ludingreferralsandresourcesforsocialwork, e. Follow‐upandoutpatientmanagement,incedicine.

. rehabilitationandphysicalm4 Toperformbasicclinicalprocedures,including:

eofincisions.ectedwounds.

a. Primaryclosur b. Managementofopenandinf c. Venipuncture.

d. Intravenouslineplacement.rinarycatheters.

e. PlacementofuSystems‐BasedPractice:

tontheprimaryservice.1. Toeffectivelytransfercarewhendutyhoursarecompleted.. responsibilitiesofpatientswhoareno. erationalebehindthem,including:2 Toresponsiblyaccepttheon‐callcare3 Toapplystandardizedcareplans,andth

procedures.icregimens.

a. Bowelpreparation b. Preoperativeantibiot c. S.B.E.prophylaxis.

is.s.

d. Tetanusprophylax e. Universalprecaution f. Aseptictechnique.

g. Careofcentrallines. h. Careofgastrostomies. i. Postoperativefeedingregimens(e.g.,post‐pyloricregimens).4. Toattendcareconferencesonassignedpatients.. governmentalagencies,healthcare5 Towritenoteswithsufficientdetailtosatisfytherequirementsof

ing:hysicalexaminations,andcareplans.

payerorganizations,includ a. Admissionhistories,p b. Dailyprogressnotes.

c. Dischargesummaries.DidacticCurriculum

ndHigh‐riskObstetrics).1. WeeklyDivisionpreoperativeworkconference.2. Weeklycombinedprenatalconference(withNeonatology,PerinatalMedicine,a

thPediatricPulmonology).3. WeeklyPulmonaryConference(wi4. MonthlyPediatricChairrounds(withwardservices,DepartmentofPediatrics).

urgeryintheDepartmentofSurgery).5. Dailymedicalstudentconference.. MorbidityandMortalityConference(withDivisionsofGeneralS

ent‐as‐Teacherconference(withDepartmentofSurgery).67. ResidEvaluationAttendingstaffevaluatesresidentperformancebaseduponthesixcorecompetenciesrelevanttohisorherpostgraduatelevelsummarizedabove.Theseniorresidentsassistintheevaluationofjuniorlevelresidents.End‐of‐rotationfacultymeetingsassessinadditionthestrengthsandweaknessesoftheresidents.Completedevaluationformssummarizetheseevaluations.Facultyandresidentsmeet,usingtheevaluationforasaguideorconstructivediscussion.Theymakeplanstoaddressperceivedresidentweaknesses.PartofthediscussionddressesthequalityoftheeducationalexperienceonthePediatricSurgeryfaPGY1:TRAUMASURGERYOtolaryngologyPGY1ResidentsparticipateintheDepartmentofGeneralandTraumaSurgeryatWakeMedHospitals.Residentsparticipateinallaspectoftheclinicalpracticeincludingoutpatientclinic,initialtraumassessments,intra‐operativeandpost‐operativecareoftraumapatientsacrossthedurationoftheirone(1)

rotation.amonth

alsGo

ntific1. Toapplythemostup‐to‐dateproceduresinanappropriatecontextusingsolidmedicalandscie information.2. Tocareforcomplexthermalandelectricalinjuries,advancedsurgicalconditions,andthemost complicatedcasesinamultidisciplinaryfashionusingtheskillsandknowledgeofourmedicaland nursingcolleagues.3. Toexpandthesphereofcaretoincludethecommunitynursesandsocialcarenetworkinthehome communityineffortsthatincludeeducationandcommunication.

ina4. Torespectthepatientandhisorherfamilyduringallphasesofcare,includingeffortstoprovidecare comfortable,caringenvironment.

environmentwheredecisionsareinformed,questionsareanswered,andndness.

5. Topromoteaneducationalpatientsaretreatedwithki

6. Thisisa2monthrotation.urgeryresidentsandmedicalstudents,asmembersoftheNorthCarolinaJayceeBurnCenter,willsupportthelinicalmissionandallgoalsoftheDivision.Sc

LearningObjectives–CoreCompetenciesTheemphasisofthisrotationisontheacutecareofthetraumapatient.Thisincludesinitialassessmentfollowinginjury,stabilizationandresuscitation,pre‐operativeevaluation,intra‐operativemanagement,

e,andoutpatientfollow‐up.postoperativecarProfessionalism:1. ThePGY1isexpectedtoparticipateinORcases,inclinic,orinICUmanagementonadaytodaybasis.. Bywayofexampleanddirectinstructiontomedicalstudents,todemonstrate compassionandintegrity

milyinteractions,andcommunicationwithotherhealthcareproviders.2 throughrespectfulpatientcare,faInterpersonal&CommunicationSkills:1. ThePGY1shouldunderstandthathisorherprimaryroleistogatherinformationforthePGY3and

attendingstomakeinformeddecisionsabouttreatmentplans,aswellastocarryoutthosetreatment plans.

spitalcourse,includingaprecise2. ThePGY1isexpectedtoassistindocumentingfullythepatient’shohistoryandphysical,comprehensivedischargesummaryanddailyprogressnotes.

3. Toreviewteamordersandprogressnotesfordetailandaccuracy.nathoughtful,respectful4. Toprovideinformedopinionsduringconsultationswithotherservicesi

process. manner.5. Toadvisepatientsandfamilymembersinthedecisionmaking

edconsentfrompatientsorfamilymembers.6. Toobtaininform

inoneofthesurgicaltextbooks.MedicalKnowledge:. ThePGY1isexpectedtoreadachapterontraumacare

uledconferences.12. Tocontributesubstantivelyinsched

ctiPra ce‐BasedLearning&Improvement:1. Tocontributetoworkroundssothatdiagnosticandtreatmentissuesareidentifiedandcaretasksare initiatedandcompletedinanappropriateandtimelymanner.. Toprovideinformationandresourcessothattheteamunderstandsthemedical,surgical,andscientific

apatient’sconditionandhisorhertreatmentplan.2 basesof

tienPa tCare:1. Learntoevaluatepatientswithminortomulti‐systemtrauma,includingassessmentfortheneedfor hospitalization,aswellasimmediateresuscitationneeds.ThePGY1shouldbeabletocommunicatethis assessmenttothePGY3(chiefresident)ortotheattending.2. ThePGY1isexpectedtoroundonadailybasisonhospitalizedpatients,performingacompletephysical

piling examination,acquiringanupdateonpertinentlaboratoryandradiologicalexaminations,andcom thisinformationintoaconcisepresentationtobemadeonmorningrounds.3. ThePGY1shouldbeabletoevaluatethetraumapatientforneedsrelatedtofluidandelectrolyte

supplementationfor management,assessmentandtreatmentofpainandanxiety,andappropriate

dintensivecaresetting. nutritionalneeds.4. Tobeabletoinitiatetreatmentinthetraumabayan5. Toprovideadvancedtraumacareandlifesupport.

6. ThePGY1shouldbeabletorecognizetheneedforassessmentofthetraumapatientforinfections,t shouldbeabletofollowanalgorithmfordiagnosingthesourceofinfection,andinitiatingatreatmen

planthatincludesappropriateantibiotics.7. ThePGY1isexpectedtobecomeproficientatarterialandvenouscatheterizationinthetraumabay, includingtheplacementofpercutaneousfemoralvenouslines,andplacementofperipheralintravenous

lines.UndersupervisionofthePGY3,thePGY1isalsoexpectedtobecomeproficientinplacementof subclavianandinternaljugularvenouslines.8. ThePGY1willbeexpectedtoassessthepatientfornutritionalstatus.Thiswillincludeassessingthe extentofthepatient’sweightloss,trackingtheweeklyserumproteinslevels,followingthedietitian’s notesinthechart,anddeterminingtheappropriatetimingformetaboliccartstudies.ThePGY1will

alsobeexpectedtounderstandtherationalefortheenteralfeedingsemployedinthesupportoftheburn patient.9. ThePGY1willbeexpectedtoassessthepatientinitiallyforneedforintubation,eitherbecauseofsmoke inhalationinjury,swellingoftheupperairway,orcarbonmonoxidepoisoning.Duringthesubsequent hospitalization, thePGY1willalsobeexpectedtolearnmanagementoftheventilator,aswellasto preparethepatientforweaningandextubation.11. ThePGY1willbeexpectedtoanticipateandidentifythepatientgoingintosepticshock.Subsequently

thePGY1willbeexpectedtomanagethefluidresuscitationofthepatient,aswellasworkwiththePGY3ginotropicsupport.

intermsofmanaginSystems‐BasedPractice:1. Toassurethatprioritiesofcareandservicedutiesaretransferredcompletelyandresponsiblyon changesindutyhours.2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.3. Tosupervisetheapplicationofstandardizedcareplans.. Toidentifyproblemsandinefficienciesintheprovisionofpatientcare,anddevisemeansofassessing

andaddressingthem.4PGY1:NCJAYCEEBURNCENTERClinicalMissionheclinicalmissionoftheNorthCarolinaJayceeBurnCenterattheUniversityofNorthCarolinaatChapelHill

rovidethehighestlevelofcaretopatientsofallageswithskintraumaorskindiseases.Tistop

alsGo

ntific1. Toapplythemostup‐to‐dateproceduresinanappropriatecontextusingsolidmedicalandscie information.2. Tocareforcomplexthermalandelectricalinjuries,advancedsurgicalconditions,andthemost complicatedcasesinamultidisciplinaryfashionusingtheskillsandknowledgeofourmedicaland nursingcolleagues.3. Toexpandthesphereofcaretoincludethecommunitynursesandsocialcarenetworkinthehome communityineffortsthatincludeeducationandcommunication.

ina4. Torespectthepatientandhisorherfamilyduringallphasesofcare,includingeffortstoprovidecare comfortable,caringenvironment.5. Topromoteaneducationalenvironmentwheredecisionsareinformed,questionsareanswered,and patientsaretreatedwithkindness.

6. Thisisa1monthrotation.urgeryresidentsandmedicalstudents,asmembersoftheNorthCarolinaJayceeBurnCenter,willsupportthe

n.SclinicalmissionandallgoalsoftheDivisioLearningObjectives–CoreCompetenciesTheemphasisofthisrotationisontheacutecareoftheburnpatient.Thisincludesinitialassessmentollowinginjury,stabilizationandresuscitation,pre‐operativeevaluation,intra‐operativemanagement,fpostoperativecare,andoutpatientfollow‐up.AprimarymissionoftheNorthCarolinaJayceeBurnCenteristotraingeneralsurgeonstoprovideahighlevelfburnsurgicalcareappropriatetoacommunitygeneralsurgicalpractice,andtoprepareselectedtraineesforoadditionalspecialtytraininginburnsurgeryataburnsurgicalfellowship.Objectivesreflectteamwork;i.e.,theskillsandresponsibilitiesblendsothattheycomplementcontributionsfromothermembersofthephysicianteamandrecognizetheinputfromnursingandotheralliedhealthprofessionals.ManyobjectivesarenotspecifictotheNorthCarolinaJayceeBurnCenter,however,andare

GY1levelsrotations.reinforcedinallPProfessionalism:1. ThePGY1isexpectedtoparticipateinORcases,inclinic,orinICU managementonadaytodaybasis.

2. Bywayofexampleanddirectinstructiontomedicalstudents,todemonstratecompassionandintegrity throughrespectfulpatientcare,familyinteractions,andcommunicationwithotherhealthcareproviders.. ThePGY1isexpectedtobepresentintheburncenterasmuchaspossible,duringthoseperiodswhenhe3 orsheisoncall.Interpersonal&CommunicationSkills:1. ThePGY1shouldunderstandthathisorherprimaryroleistogatherinformationforthePGY3and

attendingstomakeinformeddecisionsabouttreatmentplans,aswellastocarryoutthosetreatment plans.

2. ThePGY1isexpectedtodocumentfullythepatient’shospitalcourse,includingaprecisehistoryandtes.

. physical,comprehensivedischargesummaryanddailyprogressno3. Toinstructmedicalstudentsonpresentationskillssothatclinicalinformationisclearandconcise4. Toreviewteamordersandprogressnotesfordetailandaccuracy.

nathoughtful,respectful5. Toprovideinformedopinionsduringconsultationswithotherservicesi

process. manner.6. Toadvisepatientsandfamilymembersinthedecisionmaking

edconsentfrompatientsorfamilymembers.7. Toobtaininform

oneofthesurgicaltextbooks.MedicalKnowledge:. ThePGY1isexpectedtoreadachapteronburncarein

uledconferences.12. Tocontributesubstantivelyinsched

ctiPra ce‐BasedLearning&Improvement:1. Tocontributetoworkroundssothatdiagnosticandtreatmentissuesareidentifiedandcaretasksare initiatedandcompletedinanappropriateandtimelymanner.

2. Toprovideinformationandresourcessothattheteamunderstandsthemedical,surgical,andscientificapatient’sconditionandhisorhertreatmentplan. basesof

tienPa tCare:1. Learntoevaluatepatientswithsmalltomoderatesizedburns,includingassessmentfortheneedfor

this hospitalization,aswellasimmediateresuscitationneeds.ThePGY1shouldbeabletocommunicate assessmenttothePGY3(chiefresident)ortotheattending.2. ThePGY1isexpectedtoroundonadailybasisonallhospitalizedpatients,performingacomplete

ns,and physicalexamination,acquiringanupdateonpertinentlaboratoryandradiologicalexaminatio compilingthisinformationintoaconcisepresentationtobemadeonmorningrounds.3. ThePGY1shouldbeabletoevaluatetheburnpatientforneedsrelatedtofluidandelectrolyte

lementationfor management,assessmentandtreatmentofpainandanxiety,andappropriatesupp nutritionalneeds.4. Tobeabletoinitiatetreatmentintheemergencyroomandintensivecaresetting.5. Toprovideadvancedtraumacareandlifesupport.6. ThePGY1isexpectedtoparticipateinthecase,includingmakingandapplyingburndressings, harvestingskinforautografting,meshingbothautoandhomograft,preparingthewoundbedfor grafting,andapplyingtheskingraftstothewoundbed.7. ThePGY1shouldbeabletorecognizetheneedforassessmentoftheburnpatientforinfections,should

t beabletofollowanalgorithmfordiagnosingthesourceofinfection,andinitiatingatreatmentplantha includesappropriateantibiotics.8. ThePGY1isexpectedtobecomeproficientatarterialandvenouscatheterizationintheburnintensive careunit,includingplacementofpercutaneousarteriallines(includingPiCCOcatheters),placementof percutaneousfemoralvenouslines,andplacementofperipheralintravenouslines.Undersupervisionof

lar thePGY3,thePGY1isalsoexpectedtobecomeproficientinplacementofsubclavianandinternaljugu venouslines.9. ThePGY1willbeexpectedtoassessthepatientfornutritionalstatus.Thiswillincludeassessingthe extentofthepatient’sweightloss,trackingtheweeklyserumproteinslevels,followingthedietitian’s notesinthechart,anddeterminingtheappropriatetimingformetaboliccartstudies.ThePGY1will

alsobeexpectedtounderstandtherationalefortheenteralfeedingsemployedinthesupportoftheburn patient.10. ThePGY1willbeexpectedtoassessthepatientinitiallyforneedforintubation,eitherbecauseofsmoke inhalationinjury,swellingoftheupperairway,orcarbonmonoxidepoisoning.Duringthesubsequent hospitalization,thePGY1willalsobeexpectedtolearnmanagementoftheventilator,aswellasto preparethepatientforweaningandextubation.11. ThePGY1willbeexpectedtoanticipateandidentifythepatientgoingintosepticshock.Subsequently

thePGY1willbeexpectedtomanagethefluidresuscitationofthepatient,aswellasworkwiththePGY3ginotropicsupport.

intermsofmanaginSystems‐BasedPractice:1. Toassurethatprioritiesofcareandservicedutiesaretransferredcompletelyandresponsiblyon changesindutyhours.2. Toresponsiblyaccepttheon‐callcareresponsibilitiesofpatientswhoarenotontheprimaryservice.3. Tosupervisetheapplicationofstandardizedcareplans.4. Toidentifyproblemsandinefficienciesintheprovisionofpatientcare,anddevisemeansofassessing andaddressingthem.

Didacticcurriculum1. WeeklyInterdisciplinaryTeamConfere

nference.dRounds.

nce.2. MorbidityandMortalityCo3. DepartmentofSurgeryGran4. Residenttopicconference.5. Lifeafterresidencycourse.

entasteacherconference.6. ResidEvaluationResidentsareevaluatedbythefaculty.Theseniorresidentsparticipateintheevaluationofthejuniorresidents.End‐of–the‐rotationfacultymeetingsassessthestrengthsandweaknessesoftheresidents.Evaluationformsarecompletedandtheresidentsareencouragedtomeetwiththefacultyattheconclusionoftherotation.Feedbackisdistributedduringtherotationsuchthatresidentscanaddressdeficiencies.Thefacultytakesintoaccountpatientcare,operativetechniques,attitudeandcommunicationwithothers.Theopinionsofparamedicalpersonnel,patients,familiesandothersareconsideredduringtheevaluationprocess.heresidentsareencouragedtoprovidefeedbacktothefacultyregardingthestrengthsandweaknessoftheurgicalexperienceattheNorthCarolinaJayceeBurnCenter.TsPGY1:PLASTICSURGERYGoalsUnderstandthetreatmentofwoundcare,skinclosuretechniques,andwoundmanagementintheoverallurgicalmanagementofthepatient.Inaddition,theresidentshouldappreciatethecomplexityand

cleftpalate.Thisisa1monthrotation.sinterdisciplinarycareofthepatientwitha

rnLea ingObjectives–CoreCompetenciesProfessionalism:

ectfulpatientcare,familyinteractions,and1. Todemonstratecompassionandintegritythroughresp communicationwithotherhealthcareproviders.2. Tounderstandwhenexpertmedicalcareisnecessary.. Toobtainexpertmedical,surgical,nursing,orother(alliedhealth,socialwork,legal)opinionswhen

ndtrainingarereached.3 limitsofknowledge,experience,a

Interpersonal&CommunicationSkills:

ear.1. Topresentclinicalinformationonworkroundsclearlyandconcisely.2. Towriteprogressnoteswithsufficientdetailsothatpatient’scondition,status,andcareplansarecl3. Toworkeffectivelywithattendingstaff,housestaff,medicalstudents,nurses,physician’sassistants, ancillarypersonnel,andothermembersofthehealthcareteam.

ts,4. Tokeepseniorresidentsandattendingstaffinformed,particularlywithcomplexcases,unstablepatien post‐operativepatients,andchangeswithpatientcondition.

d5. Tofosterteamworkandaworkenvironmentbaseduponcommunication,respect,trust,honesty,an altruism.6. Tofosterasocialenvironmentbasedupontoleranceforotheropinions,backgrounds,andcultures, withoutdiscriminationbasedupongender,race,religion,age,sexualpreference,economicstatus,or bodyimage.

MedicalKnowledge:1. Toexpandthefundofknowledgeinplasticsurgeryfromtextbooks,journals,ande‐media.

uponmethodologyandstatisticaltechniques,surveyofrelatedswithattendingstaffandotherexperts.

2. Tocriticallyevaluatetheliterature,based articles,andresident‐initiateddiscussion

ces.3. Toparticipateinscheduledconferen

ctiPra ce‐BasedLearning&Improvement:1. Toevaluatepatientscritically,withthegoalofdevelopingaworkingdiagnosisandtreatmentplan.2. Tounderstandthemedicalandsurgicalbasisofapatient’sconditionandtreatmentplan.. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,workup,orhospitalcourse,when

ry.3 necessa

ienPat tCare:. ts. ding:1 Toknowup‐to‐presentdetailsofallassignedpatien2 Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,inclu a. Obtainingclinicalinformationfrompatients.

hospitaldepartments(e.g. b. Obtainingrelevantinformationfromnurses,houseofficers,and radiology,laboratory,hospitalinformationsystems).

gphysiciansandhospitals.. c. Obtaininginformationfromreferrin3 Tolearntheprinciplesofpre‐andpost‐operativemanagement,including: a. Fluidandelectrolytemanagement.

dingpainandsedation,antibioticdosingandpharmacology,DVTreetissuetransfer.

b. Pharmacologicmanagement,inclunticoagulationforf

sessment. prophylaxis,a c. Flapphysiologyandas

d. Woundcare. e. Donorsiteevaluation. f. Managementofdrains. g. Familiaritywithsubatmosphericspongedressings(woundVAC),tissue‐engineeredskin replacements(Integra,AlloDerm,TransCyte),topicalantimicrobials(Thermazene,Sulfamylon, silvernitrate,Acticoat),topicalgrowthfactors(Panafil,Regranex),andleeches(Hirudomedicinalis).

ludingreferralstosocialwork,homehealthnursing, h. Follow‐upandoutpatientmanagement,inc

. rehabilitationandphysicalmedicine.

es,including:ctedwounds,includingdebridementanddressingcare.

4 Toperformbasicclinicalprocedurfopenandinfe a. Managemento

b. Primaryclosureofincisions.

s. c. Venipuncture.

d. Placementofurinarycatheter e. Applicationofleeches.

alanesthetics. f. DeliveryoflocSystems‐BasedPractice:

hoarenotontheprimaryservice.1. Toeffectivelytransfercarewhendutyhoursarecompleted.. ponsibilitiesofpatientsw. p erstandtheirrationale:2 Toresponsiblyaccepttheon‐callcareres

lansandundcregimens.

3 Toa plystandardizedcarep a. Peri‐operativeantibioti b. Universalprecautions.

c. DVTprophylaxis. d. Draincare.

altherapy. e. Pulmonarytoilet.

ysic f. Post‐operativeph g. Careofcentrallines.

h. Flapmonitoring. i. Anticoagulationforfree‐tissuetransfer.4. Toattendcareconferencesonassignedpatients.. consultantphysicians,discharge

hcarepayerorganizations,including:5 Towritenoteswithsufficientdetailtosatisfytherequirementsof

ves,governmentalagencies,andhealtysicalexaminations,andcareplans.

planners,legalrepresentati a. Admissionhistories,ph

b. Dailyprogressnotes.c. Dischargesummaries.

PGY1:THORACICSURGERYGoals/EducationalMissionAmissionoftheDivisionistotraingeneralsurgeonstoprovideahighlevelofsurgicalcareappropriatetoacommunitygeneralsurgicalpractice,toknowwhentoreferpatientstoacertifiedthoracicsurgeonandtoprepareselectedtraineesforadditionalspecialtytraininginacertifiedthoracicsurgeryresidency.Objectivesreflectteamwork;i.e.,theskillsandresponsibilitiesblendsothattheycomplementcontributionsfromotherembersofthephysicianteamandrecognizetheinputfromnursingandotheralliedhealthprofessionals.

rotation.mThisisa1monthClinicalMissionrovidethehighestlevelofcareforpatientswithcongenitalandacquiredconditionsofthechestincludingthe

hestwallandassociatedorgansandstructures.Pheart,lungs,esophagus,cOverviewoftheDivisionTheDivisionisaclinicallybusyunitthatprovidessurgicalcareforpatientswithallsixcorecompetenciesputforthbytheAccreditationCouncilofGraduateMedicalEducation.Theseincludecongenitalmalformationsandacquireddiseasesoftheheart,thorax,trachea,esophagus,andlung.Thisincludesthesurgicaltreatmentofend‐stagediseaseoftheheartandlungs,includingheart,lungandheart‐lungtransplantationandtheutilizationofmechanicalcirculatoryassistdevicesbothfortemporaryandpermanenttreatment.TheDivision

gheart,lung,esophagealandgreatvesselinjuries.alsotreatsmajorthoracictrauma,includin

rnLea ingObjectives–CoreCompetenciesProfessionalism:

tfulpatientcare,familyinteractions,and1. Todemonstratecompassionandintegritythroughrespec communicationwithotherhealthcareproviders.2. Tounderstandwhenexpertmedicaladviceisnecessary.. Toobtainexpertmedical,nursing,orotheropinionswhenlimitsofknowledge,experience,andtraining3 arereached.Interpersonal&CommunicationSkills:1. Topresentclinicalinformationonworkroundsclearlyandconcisely.

2. Towriteprogressnoteslegiblywithsufficientdetailsothatpatients’condition,statusandcarepla clear.

nsare

3. Toworkeffectivelywithattendingstaff,housestaffcolleagues,medicalstudents,nurses,ancillary personnel,pre‐hospitalpersonnel. oblem”cases,4. Tokeepthoracicsurgeryresidentsandattendingstaffinformed,particularlywith“pr

unstablepatients,andchangesin‐patientconditionandcareplan.. Tofosterteamworkandaworkenvironmentbaseduponrespect,trust,andhonesty.

alenvironmentbasedupontoleranceforotheropinions,backgrounds,andcultures.56. Tofosterasoci

.MedicalKnowledge:1. Toexpandthefundofknowledgeinthoracicsurgeryfromtextbooks,journals,andelectronicmedia

uponmethodologyandstatisticaltechniques,asurveyofcussionswithattendingstaffandotherexperts.

2. Tocriticallyevaluatetheliteraturebasedt‐initiateddisconferences.

relatedarticles,andresiden. Toparticipateinscheduled34. Toteachmedicalstudents.

ctiPra ce‐BasedLearning&Improvement:1. Toevaluatepatientscriticallywiththegoalofcomingupwithaworkingdiagnosisandtreatmentplan.

ent2. Tounderstandthemedical,surgical,andscientificbasesofapatient’sconditionandhisorhertreatm plan.. Toobtainconsultationsandotheropinionsregardingapatient’sstatus,work‐up,orhospitalcourse

cessary.3 whenne

ienPat tCare:..1 Toknowup‐to‐presentdetailsofallassignedpatients.2 Togatherandinterpretessentialandaccurateinformationaboutthepatient’shealthstatus,including: a. Learningtoobtainclinicalinformationfrompatientsandfamilymembers.

ments(e.g.,radiology,laboratory, b. Obtainingrelevantinformationfromnursesandhospitaldepart andhospitalinformationsystems).

gphysiciansandhospitals.. gement,including: c. Obtaininginformationfromreferrin3 Tolearntheprinciplesofpreandpostoperativemana a. Fluidandelectrolytemanagement.

ioticdosingandpharmacology. b. Managementofpleuralairandfluidcollections.

icalmanagement,includingpainandsedation,antib c. Pharmacolog d. Recognitionandmanagementofrespiratorydistressandshock.

e. Woundcare.ludingreferralsandresourcesforsocialwork, f. Follow‐upandoutpatientmanagement,inc

edicine.. rehabilitationandphysicalm4 Toperformbasicclinicalprocedures,including:

dwounds. a. Primaryclosureofincisions. b. Managementofopenandinfecte

. c. Intravenouslineplacement.

etersesis.

d. Placementofurinarycathe. Performanceofthoracentf. Placementofchesttubes.

Systems‐BasedPractice:

tontheprimaryservice.1. Toeffectivelytransfercarewhendutyhoursarecompleted.. responsibilitiesofpatientswhoareno. erationalebehindthem,including:2 Toresponsiblyaccepttheon‐callcare3 Toapplystandardizedcareplans,andth

procedures.icregimens.

a. Bowelpreparation b. Preoperativeantibiot c. S.B.E.prophylaxis.

is.s.

d. Tetanusprophylax e. Universalprecaution f. Aseptictechnique.

g. Careofcentrallines. h. Careofchesttubes. i. Postoperativefeedingregimens.4. Toattendcareconferencesonassignedpatients.. governmentalagencies,healthcare5 Towritenoteswithsufficientdetailtosatisfytherequirementsof

ing:ysicalexaminations,andcareplans.

payerorganizations,includ a. Admissionhistories,ph b. Dailyprogressnotes.

summaries. c. DischargeDidacticCurriculum1. WeeklyDivisionpreoperativeconference.

eryconference.ogy).

2. WeeklycombinedPediatricCardiologyandThoracicSurgithCardiolonference.

3. WeeklyCardiacCatheterizationConference(w4. WeeklyMultidisciplinaryThoracicOncologyC5. Dailymedicalstudentconferenceasassigned.. MonthlyMorbidityandMortalityConference.. MonthlyThoracicSurgeryDidacticCurriculumConference.67Evaluationttendingstaffevaluatesresidentperformancebaseduponthesixcorecompetenciessummarizedabove.Thehoracicsurgeryresidentsassistintheevaluationofresidents.AtPGY1:ANESTHESIA:GoalsThegoalsforthePGY1residentrotatingonAnesthesiaprimarilyrelatetojointcareoftheairway.Theresidentshouldunderstandtheprocessofadministeringgeneral,localandregionalanesthesiaandshouldppreciatetherisksofanesthesia.Onegoalofthisrotationistoestablishcamaraderiewithacloseserviceto

eremainderoftheresidency.Thisisa1monthrotation.aourownthatwillhopefullycontinuefortharnLe ingObjectives–CoreCompetencies

Pr nesthesiaEvaluation:A. Therotatorshallacquireanappreciationofthepreoperativeevaluationofthesurgicalpatient.Thisis demonstratedby:

e‐A

1 Conductingseveralpreanestheticassessments,including:ngapertinenthistory

ysicalexamination,includingassessmentof:

. a. Takingandrecordi

. rfo b Pe rminganappropriateph i. Airway ii. Cardiovascularsystem iii. Respiratorysystem c. Reviewingpertinentlaboratorydata d. AssigningappropriateASAphysicalstatus

thefollowingfactorsmayinfluencethepatient’scourseduringtheperioperative 2. Discussinghow period:

a. Age

gelectiveversusemergencybutnotlimitedto:

b. Natureofsurgery,includin. rdi c Ca ovasculardisorders,including

tion i. Anginapectoris

nfarclure

ii. Recentmyocardialii iii. Congestiveheartfa

iv. Hypertension v. Dysrhythmia

.n

d Respiratorydisordersd/orlowerrespiratoryinfectio

ydisease i. Upperan ii. Chronicobstructivepulmonar iii. Asthma iv. Obstructivesleepapnea

intubation v. PFTsandbloodgases

ddifficultdisorders

vi. Knownorsuspecte. tr e Cen alnervoussystem

uma i. Headtra ii. Seizuredisorders iii. Strokes

legiae

iv. Quadriplegiaorparap v. Increasedintracranialpressur

. s f Gastrointestinaldisorder i. Gastroesophagealreflux ii. Bowelobstruction

ociatedwithafullstomachiency,portalhypertension

iii. Othersituationsass iv. Hepatitis,hepaticinsuffic

. g Genitourinarydisorders

y i. Renalinsufficiency

denc ii. Dialysisdepen. h Hematologicaldisorders

i. Anemia ii. Sicklecelltraitordisease

setoanesthesia iii. Coagulopathies

. rso i Pe nalorfamilyhistoryofunusualrespon i. Malignanthyperthermia ii. Abnormalsuccinylcholinemetabolism

iii. Unexplainedpostoperativefeverorjaundice j. Lifestylefactors i. Smoking

ty ii. Obesi iii. Substanceabuse

. egn k Pr ancyt,teratogenesis i. Fetaldevelopmen

ii. Hypertensivedisorders,pre‐eclampsia

. rent iii. Prematurelabor 3 Medicationhistoriesandtheinfluenceofchronicandcur medicationsontheperioperativeperiod,including: a. Whichdrugsshouldbecontinuedordiscontinued

ltingfromabruptdiscontinuationofsomeclassesofdrugs, b. Thereboundphenomenaresu notablybetablockersandclonidine c. Perioperativeglucosecontrol

tsonanticoagulants.

d. Perioperativemanagementofpatien 4 Demonstratingunderstandingofinformedconsent,including: a. Explanationofriskandalternatives

b. Whenapatientiscapableofgivingconsent,andwhenitmaybeinvalidwhichmaybeencounteredintheconscientiouspursuitofinformedconsent

c. DilemmasPre‐OperativeMedication:

onstrateknowledgeoftheprinciplesofeffectivepre‐anesthesiamedicationbyseofdrugsfor:

A. Therotatorshalldemstatingtheobjectivesforu

1. Narcoticsanyl a. Fent

b. Morphine 2. Sedatives

zepines a. Benzodia b. Barbiturates

:Clonidine,Dexmedetomidine c. Propofol d. Alphaagonists

. 3 Anticholinergics a. Atropine b. Glycopyrrolate

cidenceofconsequencesofpulmonaryaspiration c. Scopolamine 4. Drugsusedtoreducethein

nistsramide

a. H2antago b. Metoclop

ids c. AntacTheOperatingRoom:. withtheA Rotatorwillprescribeandconductappropriateintraoperativefluidandelectrolytetherapy

guidanceofhisinstructor: 1. Explainingtherationalesforestablishingbothcentralandperipheralvenousaccess 2. Identifyingthecommonsitesforvenousaccessandthecontraindicationsandindicationsforeach

3 Demonstratingskillatestablishingvenousaccessby:

libers

. a. Usingsteriletechnique

athetersofvariousca b. Successfullyinsertingseveralperipheralc c. Protectingthevenipuncturesiteandimmobilizingthecatheter 4. Prescribingmaintenancefluidandelectrolytes

ance a. Predictinghowthevariousconditionswillalterrequirementsforperioperativemainten therapy

. scu perativeconsiderationswhichaltermaintenancefluidandelectrolyte b Di ssingintrao therapyincluding:

i. Bloodloss ii. Insensibleloss

.. thefollowingmonitorsofvolumestatus:

iii “Thirdspace”lossetingdatafromofthepatient

c Correctlyinterpr i. Examination ii. Vitalsigns iii. Urineoutput

. benefitsofcrystalloid,colloid,andbloodproduct d Discussingindications,risks,and replacementtherapies

i. Regardingthefunctionsof

apacity ‐ Bloodvolume

c ‐ Oxygencarrying ‐ Coagulation ‐ Immunity. eB Inordertodemonstrateunderstandingoftheprinciplesandpracticeofroutineintraoperativ

monitoring,therotatorwill: 1. ExplainanddemonstrateECGleadplacementandselectioninoptimizingdetectionof

dysrhythmiasandischemiaariousnon‐invasiveandinvasive 2. Compareandcontrasttheinterpretationofdataobtainedbyv

. mo analysisintermsof methodsformonitoringbloodpressure

ofarterialbloodgase

3 De nstrateresults a. Oxyhemoglobindissociationcurv b. Shuntfraction c. Ventilation‐perfusionmismatch d. Acid‐basestatus

frominjurywhileheisC. Therotatorshallcorrectlypositionandpadthepatientinordertoprotecthim

.unconscious

D Therotatorwilldemonstrateproperairwayandventilatorymanagementby:irwaymanagementbymaskvs.laryngealmask 1. Describingtheindications,risksandbenefitsofa

). nt f: airway(LMA)vs.endotrachealintubation(ETT

dicationsforuseo 2 Ide ifyingandstatingthein a. Curvedandstraightbladelaryngoscopes b. Oralandnasalairways

. ryngealandlaryngotrachealanatomyayobstructionwithmaskventilation,using:

3 Describingandidentifyingbasicorophaomingupperairwingofthepatient

4. Identifyingandoverc a. Properposition b. Jawthrust

c. Nasopharyngealairway

tion. d. Oropharyngealairway 5. Successfullyintubatingseveralpatientsandidentifyingendotrachealvs.esophagealintuba

dequacyofventilation 6. Recognizinganddiscussingtheneedformechanicalventilation.

. thevariousmethodsofmonitoringfora

. edi ventilatorysupport,using: 7 Comparingandcontrasting 8 Pr ctingprobableneedforcontinued

tidalvolume a. Bloodgasanalysis

teandssure

b. Respiratoryra c. Inspiratorypre d. Vitalcapacity e. Shuntfraction 9. Prescribingappropriateparametersformechanicalventilation

.. 10 DescribingandcorrectlyidentifyingindicationsforextubationE Therotatorwilldemonstrateknowledgeofproceduresandpracticeinductionofanesthesia: 1. Discussingtheindications,contraindications,risksandbenefitsofthefollowinginductionof

anesthesia.te 2. Describingandidentifyingindicationsforrapidsequenceinductionanddiscussingappropria

techniques.traoperativemethodsofrecognizingandtreatingvariouscardiovascularF. Therotatorwilldiscussin

ble :pro ms,including 1. Hypertension

2. Hypotension3. Dysrhythmias

PGY1:EMERGENCYMEDICINE:GoalsUnderstandtheemergencyroomaspartofthelargersystemofhealthcaredelivery.Specifically,theemergentresentationofairwaydisorders,bleedingorcardiacproblemsshouldbeunderstood.Thisisa1monthprotation.arnLe ingObjectives–CoreCompetencies

Professionalism:. Developpersonaltechniquesforstressmanagement,physicalandmentalhealth,andcriticalincident

wellnessandcareerlongevity.1 stressdebriefingthatwillpromoteInterpersonal&CommunicationSkills:1. Useconsultantsinatimelyandprofessionalmannerforcriticallyillpatients.2. Developtheabilitytoeffectivelyuseavailableresourcesincludingtraditionalreferences,on‐line

databases,medicalliteraturedatabasesandspecialtyconsultants,inordertoidentifyandinstitutethetemanagementforindividualpatients.

mostappropria

.MedicalKnowledge:1 SolidifythefollowingclinicalframeworktobeusedinapproachingallEDpatients: a. Identifypotentiallife,limb,andorganthreats. b. Stabilizesuchpotentiallife,limb,ororganthreatsusingacquiredskillincertaincriticalprocedures.

c. Learnknowledgeofairwaymanagementofthecriticalairway.d. Learndispositionofpatientswithappropriateregardtopatienteducation,advocacy,risk

managementandfollow‐up.

actir ce‐BasedLearning&Improvement:

andandappropriatelyfollowtheEMTALAlegislationwithregardtoEmergencyRoomCare.P1. Underst

tienPa tCare:. Masterrecognitionandmanagementoflife‐,limb‐,andorgan‐threateningdiseasesandinjuriesin1 patientsofallages

stemy s‐BasedPractice:. Utilizeappropriatediagnosticstudiesinatime‐andcost‐effectivemanner.S1PGY1:OTOLARYNGOLOGY:GoalsAstructured3monthOtolaryngologyexperienceoccursduringthePGY1yearforeachresident.Thisrotationemphasizesthework‐upandperi‐operativemanagementofsurgicalOtolaryngologypatientsacrosstheentirespectrumofthefield.PGY1residentsparticipateinclinicalOtolaryngologyrounds,managefloorandICUatientsandtakeshadow‐callwithjuniorresidents(PGY2and3).TheyarealsointroducedtooperativepOtolaryngologyatapreliminarylevel.LearningObjectives–CoreCompetenciesProfessionalism:1. PGY1residentsareanticipatedtoparticipateinallaspectsofclinicalcareincludingthepatient notificationofdiagnoseswiththeaccompanyingpost‐notificationconsultation.Supervisionisprovided

insuchendeavorsbothbythechiefresidentofthespecificserviceaswellastheassociatedattending physician.Interpersonal&CommunicationSkills:1. Residentscommunicateonadailybasiswithpatientsinthepre‐operativeprocessaswellasinteracting withpatientsontheinpatientOtolaryngologyward.Theyarealsoanticipatedtocommunicateina

timelyandefficientmannerwithattendingsurgeonsregardingproblemsorunanticipateddetailsepre‐operativework‐upprocess.

arisingduringthMedicalKnowledge:1. PGY1residentsparticipatefullyinthedepartmentalcurriculumduringtheirtimeonservice.This includesregulartopicallectures,journalclubs,grandrounds,visitingprofessorandanatomy dissections/demonstrations.

actPr ice‐basedLearning&Improvement:1. ThePGY1residentisintendedtogainexperienceandknowledgebyperformingthepre‐operative evaluationandexaminationofOtolaryngologypatientswithknowndiagnoses.Continuousfeedbackis offeredbyattending physiciansregardingthedetailsofthework‐upprocess.Residentsare anticipatedtoanswerpatientquestionswithinthelimitsoftheirknowledgebaseregardingspecificperi‐

operativeproceduraldetails.Theirknowledgeisaugmentedbysittinginonpre‐operativeconsultationstheattendingphysicianandtheirpatients. between

tienPa tcare:1. PGY1residentsparticipateinOtolaryngologywardrounds,managefloorandICUpatientsandtake “shadow‐call”withjuniorresidents.Duringthistimeresidentsshouldprovidecompassionate, appropriateandeffectivecareforthetreatmentofhealthproblemsencounteredbothontheinpatient hospitalwards,intheEmergencyDepartment,andinthepre‐operativeclinicsetting.PGY1residents

participatebothasanassistanttothesurgicalteamonlargerheadandneckoncologycasesandassupervised(level‐appropriate)surgicalcases.

primarysurgeononSystems‐BasedPractice:1. PGY1residentswilllearntooperateefficientlywithinthecontextofthelargerhospitalsystemasthe

primaryliaisonbetweentheOtolaryngologyserviceandotherassociatedservicesincluding:Nutrition,SocialServices,RehabilitationServices,andtheCorelaboratoryservices.

RESEARCHPGY2:RESEARCHGoalsAstructuredresearchexperience(6months)foreachresidentoccursduringthePGY2year.Thisrotationemphasizesanunderstandingofthebasicprinciplesofstudydesign,performance,analysis,andreporting.Theesearchexperiencemaybeclinicalorbasicinnature,andwillbeundertheadvicebyandplanningofarqualifiedfacultymember.LearningObjectives–CoreCompetenciesProfessionalism:1. ResidentsaretoattendethicsinresearchseminarsofferedbytheTranslationalandClinicalSciences

Instituteorthegraduateeducationofficeasthesemaybeavailable.Residentsarealsomentoredontheresearchresults.

professionalpresentationoftheirInterpersonal&CommunicationSkills:1. Residentscommunicateonadailyorbiweeklybasiswiththeirfacultymentortodiscussobstaclesand

solutionsencounteredduringexperiments.Thisrepresentsaneffectiveexchangeofinformationandithhealthprofessionals.

collaborationwMedicalKnowledge:1. ResidentsreviewanOtolaryngologytextbookwithafacultymemberonaweeklybasis.Thisactivity helpsresidentstoestablishafoundationofbiomedicalandclinicalknowledge,aswellastheapplication ofthisknowledgetopatientcare.Residentsarealsotoattendgrantwritingseminarsofferbythe

stitute. TranslationalandClinicalSciencesIn

actPr ice‐BasedLearning&Improvement:1. Residentsthroughtheirresearchprojectbegintocriticallyappraisalandassimilationofscientific evidenceforthepurposesofgrantwriting,manuscriptpreparation,andtoultimatelyimproveinpatient

care.Residents areexpectedtoproduce2manuscriptsandpresentresultsofresearchatnationals. meeting

tienPa tcare:1. Duringtheresearchblockresidentscovercalldutiesnomorethaneveryfourthnightbeginningat5pm onweeknights.Duringthistimeresidents shouldprovidecompassionate,appropriate,andeffective

careforthetreatmentofhealthproblemsencounteredwhileconsultingfortheDepartmentof Otolaryngology.Systems‐BasedPractice:1. Researchmayinvolveprojectsthatdemonstrateanawarenessofandresponsivenesstothelarger

contextandsystemofhealthcare,aswellastheabilitytocalleffectivelyonotherresourcesinthesystemtoprovideoptimalhealthcare.

T‐32RESEARCHT32:RESEARCHGoalsAstructuredresearchexperience(2yrs)occursbetweenthePGY‐1andPGY‐2clinicalyears.Thisrotationemphasizesanunderstandingofmoreadvancedprinciplesofstudydesign,performance,analysis,andreporting.Theprimaryresearchexperienceisbasicortranslationalinnature,andwillbeundertheadvicebyndplanningofDr.Manis.Additionalclinicalprojectsareencouragedandarecarriedoutundertheguidanceaofaqualifiedfacultymember.LearningObjectives–CoreCompetenciesProfessionalism:1. ResidentsaretoattendethicsinresearchseminarsofferedbytheTranslationalandClinicalSciences

Instituteorthegraduateeducationofficeasthesemaybeavailable.Residentsarealsomentoredontheresearchresults.

professionalpresentationoftheirInterpersonal&CommunicationSkills:1. Residentscommunicateonadailyorbiweeklybasiswiththeirfacultymentortodiscussobstaclesand

solutionsencounteredduringexperiments.Thisrepresentsaneffectiveexchangeofinformationandithhealthprofessionals.

collaborationwMedicalKnowledge:1. ResidentsreviewanOtolaryngologytextbookwithafacultymemberonaweeklybasis.Thisactivity helpsresidentstoestablishafoundationofbiomedicalandclinicalknowledge,aswellastheapplication ofthisknowledgetopatientcare.Residentsarealsotoattendgrantwritingseminarsofferbythe

stitute. TranslationalandClinicalSciencesIn

actPr ice‐BasedLearning&Improvement:1. Residentsthroughtheirresearchprojectbegintocriticallyappraisalandassimilationofscientific evidenceforthepurposesofgrantwriting,manuscriptpreparation,andtoultimatelyimproveinpatient care.Residents areexpectedtoproduce2manuscriptsandpresentresultsofresearchatnational

meeting

tien

s.Pa tcare:1. Duringtheresearchblockresidentscovercalldutiesnomorethaneveryfourthnightbeginningat5pm onweeknights.Duringthistimeresidents shouldprovidecompassionate,appropriate,andeffective

careforthetreatmentofhealthproblemsencounteredwhileconsultingfortheDepartmentof Otolaryngology.Systems‐BasedPractice:1. Researchmayinvolveprojectsthatdemonstrateanawarenessofandresponsivenesstothelarger

contextandsystemofhealthcare,aswellastheabilitytocalleffectivelyonotherresourcesinthesystemtoprovideoptimalhealthcare.

WAKEMEDICALCENTERICHAELFERGUSON,MD–ASSOCIATEPROGRAMDRS.BLOEDON,DORFMAN,FERGUSON,MARSHALL

M IRECTOR,WAKEMEDDPGY2:INTRODUCTIONTOCLINICALGENERALOTOLARYNGOLOGYGoals:heprimarygoalsfortherotationatWakeMedwouldbeforthePGY2residenttoobtainclinicalexperiencein

rotation.Tabusyregionalhospital.Thisisa6montharnLe ingObjectives–CoreCompetencies

.Professionalism:1. Dressinappropriateclinicattirewithacleanlabcoat. Respectgenderandculture.

courteousmanner.23. Interactwithstaffandnursesina

ams.Interpersonal&CommunicationSkills:1. Effectivelycommunicatefindingsandtreatmentplanswithconsultingphysiciansandte. Developapositiverelationshipwithreferringandconsultingphysicians.

ingotolaryngologyphysicianinformedofallnewandongoingconsults.23. KeeptheattendMedicalKnowledge:

xtsuchasKJLeeoreMedicine.ology.

1. ReadgeneralOtolaryngologyte2. Acquirebasicscienceandclinicalknowledgeofgeneralotolaryng3. Understandthefacialskeleton.. Discusstheprinciplesofcareinthetreatmentoffacialfractures.

ecommonERandinpatientotolaryngologyconsults.45. Acquiregeneralknowledgetomanag

actiPr ce‐BasedLearning&Improvement:. Incorporateevaluationandfeedbackintodailypractice.. Performselfevaluationtoidentifyareasofweaknessandstrength.12

P tC e:a ar.tien

1 Clinic/consults: a. Demonstratecompleteheadandneckexam.

. b. Obtaindetailedpertinenthistory.

attending c. Presentpatientssuccinctlytothe d. Formulatewell‐thoughouttreatmentplan.

e. Bedsideevaluationoftheairway. f. CommonERcalls–epistaxis,PTA,softtissuelacerationsetc.

ndformulateplanforesophagealforeignbodies.onfacialtrauma–mandible,midface,orbitalfloorfractures.

g. Evaluatea

. h. Evaluatecomm2 Surgicalskills: a. Laryngoscopy. b. Nasalendoscopy. c. Tonsillectomyandadenoidectomy.

d. MyringotomyandplacementofPEtubes.

icallymphnodes. e. Excisionofsimpleskincystsandlesions. f. Excisionalbiopsyofsuperficialanddeepcerv

g. Incisionanddrainageofdeepneckabscess.ixationofthefacialskeleton.

zygoma. h. Intermaxillaryf i. ORIFofsimplefacialfractures–mandibleand

oval. j. Panendoscopy.

dyrem k. Esophagoscopywithforeignbo l. Closureofcomplexfaciallacerations. m. Nasalendoscopywithcautery. n. Removalofnasalandearforeignbodies.

nofheadandneckmasses.offacialandneckabscesses.

o. Fineneedleaspiratiop. Incisionanddrainage

tomy. q. Adulttracheos

rysystemsdifferfromoneanother.Systems‐BasedPractice:

practiceanddelivehealthcarecosts.

1. Understandhowtypesofmedical. Investigatemethodsofcontrolling. Advocateforqualitypatientcare.23PGY3:GENERALOTOLARYNGOLOGYWITHCLINICALFOCUS(RHINOLOGY,FACIALPLASTICSANDOTOLOGYGoalsTheprimarygoalsforthePGY3residentatWakeMedwouldbetoexpandtheirclinicalexperienceataregionalhospitalwiththespecificgoalsofenhancingthetraumaexperience,understandingadifferentsystemofracticethananacademichealthcenter,andfurtheringtheiroperativeexperienceinawiderangeof

nthrotation.potolaryngologicprocedures.Thisisa3moarnLe ingObjectives–CoreCompetencies

thebasisformedicine’scontractwithsociety.Professionalism:1. Understandprofessionalismas2. Wearappropriateclinicattire.

3. Treatotherteamswithrespect.Interpersonal&CommunicationSkills:1. Demonstrateactivelisteningwhileinterviewingnewpatients.. Keepattendinginformedofallinpatients.

atienttreatmentplanswithnursesandancillarystaff.23. CommunicatepMedicalKnowledge:

my.1. Earandtemporalboneanato2. Auditoryandvestibularphysiology.3. TemporalboneCTanatomy.4. Interpretaudiograms,tympanometry,OAE,ABR,reflexes.

neousdefects.5. MasterCToffacialfractures.

headandneckcuta6. Reconstructionladderfor7. Sinonasalanatomyonendoscopy.8. SinonasalanatomyonCT.9. Understandallergytestingandresultsinterpretation.0. Differentiateviral,bacterial,fungal,allergic,structuralsinusitis.

graine,psychologicalissuesastheyrelatetosinonasalcomplaints.111. UnderstandcontributionofGERD,mi

actiPr ce‐BasedLearning&Improvement:

ditionalfocus.

1. Acceptcriticism–usetoimprove.. Recognizeskillareasthatneedad

readliteraturecritically.23. Learnto

tiena are.P tc :1 Clinic/consults:

ts. a. Chronicsinuspatien b. Allergyandnasalobstruction c. Chroniceardisease. d. Evaluatepatientscomplainingofhearingloss,tinnitus,dizziness,orfacialweakness.

braneandcommonpathologyincludingotitisexterna,seroustionandcholesteatoma–usemicroscopy.

e. Identifyanormaltympanicmem otitismedia,tympanicmembraneperfora

oscopy.ardebridement.

f. Diagnosticsinonasalend ks,e ma.

g. Placementofearwic h. Temporalbonetrau i. Bonyfacialtrauma.

ergency.xis.

j. Airwayem k. Managementofepista.2 SurgicalSkills:

noplasty. a. Tympa b. Mastoidectomy.

tubes–inanawakeadult. c. FESS.

d

d. Myringotomyan e. Septoplasty. f. SMRturbinates.

g. Midfacefractures,orbit alfloorfractures,ZMCfr otidectomy.

actures. h. Introductiontothyroidectomy,par

cess. i. Pediatricneckabs j. Congenitalpediatricneckmasses.

ing. k. Rhinoplasty.

l. Reconstructionofskindefects–localflaps,skingraftm. Adulttracheostomy‐leadingamorejuniorresident.

stemy s‐BasedPractice:. Assistpatientsindealingwithsystemcomplexities.S1PGY4:SERVICECHIEFRESIDENT–HEAD&NECKCANCERFOCUSGoalsTheprimarygoalfortheservicechiefresidentatWakeMedistoperforminaleadershiproleatabusyregionalhospital.Theservicechief,inadditiontoperformingmorecomplexsurgeries,hastheultimateresponsibilityorcoordinatingschedules,communicatingwithjuniorresidentsandattendings,andrepresentingtheservice

monthrotation.ftoothersinthelargercontext.Thisisa3arnLe ingObjectives–CoreCompetencies

theircare.Professionalism:. Learntorespectandseekoutpatientsownwishesabout

tientsandcolleagues.12. Actinanaltruisticmannerwithpa

identsandattendings.Interpersonal&CommunicationSkills:

ndsenior restyphysicians.

1. Practiceappropriateinteractionswithreferringphysicians,junioraationwithcommunihtheERphysicians.

2. Understandtheimportanceofdirectcommunic. Facilitateanamicableworkingrelationshipwit

ailyplanwithjuniorresidents.34. Communicated

MedicalKnowledge:

1. Thoroughknowledgeofheadandneckanatomy.2. Usemodernimagingtoinvestigateandformulatetreatmentplanforheadandnecktumors.

juvanttherapy–radiationandchemotherapyinthetreatmentof3. Understandandemployalternativead

HeadandNecktumors.

4. Properlystageheadandnecktumors.

5. Knowlistofthyroidneoplasmsandbestcourseoftreatmentforeach.

6. Understandcommonsalivaryneoplasmsandbestcourseoftreatmentforeach.7. Understand potentialcomplicationsofcancersurgery–andwaystomanagethese.

s–skingrafts,localflaps,regionalflaps,freeflaps.

8. Knowvariousreconstructivemethod

acti

ing&Improvement:Pr ce‐BasedLearn1. Applyliteratureandstudiestoownclinicalpractices.2. Readcritically.3. Identifyownstrengthsandweaknesses–aswellasoperativedeficiencies.

4. Setlearningandskillsgoals.elearningofjuniorresidents.5. Facilitat

tiena ar.P tC e:1 Clinic/consults:

rpatients.plasms.

a. Headandneckcance b. Thyroidandsalivaryneo

ergency. c. Airwayem

. d. Neckandfacialtrauma.2 SurgicalSkills: a. Showcompetencyintheoperatingroom.

alignancies. b. Panendoscopy. c. Widelocalexcisionofaerodigestivetractm

kingraft.mentalmandibulectomy.

d. Splitthicknesss e. Marginalandseg f. Laryngectomy. g. Neckdissection.

h. Thyroidectomy. i. Parotidectomy. j. Managementofdifficultairway. k. Removalofairwayforeignbody. l. Pan‐facialfractures‐bicoronalapproach.

orresidentthroughanadulttracheostomy. m. Leadingajuni

Systems‐BasedPractice:. Understandhealthcarecosts.. Understandhowourpatientcareimpactsotherhealthcareproviders.12EDIATRICS/OTOLOGYP RS.DRAKE,ROSE,ZDANSKI/DRS.ADUNKA,BUCHMAN,PILLSBURYD

PGY3:PEDIATRICS/OTOLOGY(PO)GoalsTheprimarygoalsforthePGY3residentonthisrotationaretoappreciatethatthecareoftheinfantandchildiffersfromthatofanadult,tolearnanatomyrelevanttothetemporalbone,andtolearnthejudgment

logiccare.Thisisa3monthrotation.dinvolvedinpracticingspecialtyotolaryngoarnLe ingObjectives–CoreCompetencies

nder.Professionalism:

andgetient.

1. Addressespatientandpatients’familieswithrespecttotheirculturea.

2. Learnsandpracticesethicalbehaviorinthetreatmentofpediatricp. Activelyobserveandparticipateinthecareoftheprematureinfant. Learntomanageallaspectsofpediatricsensorineuralhearingloss34

InterpersonalandCommunicationSkills:1. Practiceempatheticlisteningskills.

gs,nursingandera

2. Practiceprofessionalinteractionswithreferringphysicians,fellowresidents,attendinp tingroomstaff.

riateinteractionswithmultispecialtycolleaguesduringon‐calltimes.o3. PracticeappropMedicalKnowledge:1. Understandindicationsforcommonsurgicalprocedures,includingpressure‐equalizationtubes,

raneperforation, tonsillectomyandadenoidectomyandtheircomplications,includingtympanicmemb

iologyandpainmanagement. bleedingandvelopharyngealinsufficiency.. Perioperativecareincludingfluidandelectrolytephys

fhearingtesting.23. Basicaudiologyandinterpretationo

acti

dacticsessions.Pr ce‐BasedLearning&Improvement:1. Participateincadaverdissectionsyearlyincorporatingprincipleslearnedfromdi. Examineownoperativelistandobtainadditionaltrainingwhennecessary.

rthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.23. Conside

tienPa tCare:. ronchoscopyandesophagoscopy,usingmagnification1 Endoscopictechniquesincludinglaryngoscopy,b viamicroscopes,telescopes,bronchoscopes. a. Tonsillectomy/adenoidectomytechniques. b. Infant/childtracheostomytechniques. c. Operativeplacementofpressure‐equalizingtubes.

d. Surgicalprocedurestoclosetympanicmembraneperforations.e. Mastoidectomy(asastandaloneoraccessprocedure).

themiddleearandlateralportionofthetemporalbone. f. ApproachestoSystems‐BasedPractice:1. LearnandparticipateinthemonthlyMorbidityandMortalityconference.2. ParticipateincodingandbillingprocessesforboththeclinicandOR.3. Understandtheissuesrelatingtodrugprescriptions,includingpediatricdosingandallergies.

ay4. Learntomanagesystemsbasedcareofinfantsandchildrenwithtracheostomiesandotherairwproblems.

. Learntomanagesystemsbasedcareofinfantsandchildrenwithsensorineuralhearingloss.5PGY4:PEDIATRICS/OTOLOGY(PO)GoalshegoalsofthePGY4rotationaretoimprovetheunderstandingoftheairwayandotologiccareofpatients

reas.Thisisa3monthrotation.TandtoimprovesurgicalskillinthesetwoaarnLe ingObjectives–CoreCompetencies

Professionalism:1. Addresspatientandpatients’familieswithrespecttotheircultureandgender.

2. Learnandpracticeethicalbehaviorinthetreatmentofpediatrisuchastracheostomies,hearingimpairedpatients,andpediatr

eprematureinfant.

cpatientswithcommunicationbarriersictumorpatients.

3. ActivelyconsiderandreadaboutcareofthInterpersonal&CommunicationSkills:. Communicatethroughaninterpreter,especiallypreoperativecounselingforaprocedure,with

sks,benefitsandalternativeprocedures.1 discussionofriMedicalKnowledge:1. Observeandunderstandbasiclasertechnology.. Understandthework‐upandtreatmentofabnormalitiesofspeechandswallow,including

ofspeechandaspiration.2 velopharyngealdysfunction,apraxia

acti

.Pr ce‐BasedLearning&Improvement:1. Participateincadaverdissectionsyearlyincorporatingprincipleslearnedfromdidacticsessions

cetodirect2. ParticipateinthemonthlyMorbidityandMortalityconferenceandusetheexperien additionalreadingontimelytopics.3. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking.. Considerthecost‐benefitanalysisofvarioustypesoftonsillectomytechniques,includingcoblation,

d‐instrumentation,andcoldsteel.4 powere

tienPa tCare:1. Participateintympanoplasty,mastoidectomyandplacementofacochlearimplant.

nicotitismediawith2. Understandtheprinciplesandparticipateintympanomastoidsurgeryforchro cholesteatoma.3. Understandthebasicprinciplesofcerebellopontineanglelesionmanagement.

4. Understandtheresectionofcongenitalneckmasses,vascularmalformations,andotherpediatrichead andneckneoplasms.

ditis,5. Understandthemedicaltreatmentoptionsforinfectionsoftheheadandneck,includingmastoi neckinfectionsandsinusitis.6. Observeandunderstandthemedicalandaudiologicwork‐upofapediatricpatientforcochlear

implantationincludingathoroughunderstandingandlimitationsofelectrophysiologicobjectivesuchasABRandOAE’s.

audiometrictesting

stemy s‐BasedPractice:. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.S1PGY5:PEDIATRICS/OTOLOGY(PO)GoalsGoalsforthechiefresidentonthisrotationinclude“running”theservice,coordinatingworkforceissues,callandinterfacingwiththeotherchiefsonotherOTO‐HNSservices.Inadditiontotheleadershiprole,thePGY5asthegoalofunderstandingthecareofcomplexearandairwaypathologyandtheskilltoaccomplishtheoredemandingsurgicalcasesinthesespecialtyareas.Thisisa3monthrotation.

hm

Le ingObjectives–CoreCompetenciesarn Professionalism:1. Addresspatientandpatients’familieswithrespecttotheirculture,genderanddisability.

tionpaidtothevariousmembersof2. LearnandpracticeethicalbehaviorintheORandclinic,withattenthehealthcareteam.

orsexually‐transmittedillness.3. Counselateenaboutblood‐borneInterpersonal&CommunicationSkills:1. Contemplatetheparentingofamedicallyfragilechild.2. Participateinaparentconferenceregardingtheplacementofatracheostomy,ventilator,implantor

othermedicaldevice.ndoflifediscussionswithcare‐giversofchildrenwithendstageorterminaldisease.

3. ParticipateineMedicalKnowledge:

‐1. Appreciatethemanifestationsofcongenitalsyndromesinvolvingtheheadandneck,includingbranchio oto‐renal,velocardiofacialsyndrome,CHARGEassociation,Treacher‐Collins,PierreRobinsequence.

tionoftemporalboneandheadandneckCTscans,MRI’sand2. ParticipateinadvancedimageinterpretaBrainLabimagingofthesinuses.

ss.3. Understandthegeneticsofhearinglo

actiPr ce‐BasedLearning&Improvement:1. ParticipateinM&Mconferencesandsuggestimprovementsinhealthcaredeliverywhenappropriate.. Recognizetheroleofthefosterfamilyandguardianshipofasickchildwhenitisneeded,aswellaswhen

cialservicestoinvestigatetheneedsofa compromisedpatient.2 touseso

tienPa tCare:1. Advancedapproachesinthetemporalboneincludingneurotologicsurgeriesandproceduresofthe lateralskullbase.2. Advancedpediatricairwayprocedures,includinglaryngotrachealreconstructionandcricotracheal resection.. Advancedendoscopicairwayapproaches,includingsupraglottoplasty,repairoflaryngealclefts,and

forairwayobstructionsecondarytoneoplasm.3 ablativetechniquesSystems‐BasedPractice:1. RecognizetheroleoftheCCCDPinmanagementofpediatricsensorineuralhearingloss.

h2. ParticipateinthemultidisciplinarycareofthepediatrictracheostomyandairwaypatientsviatheNortCarolinaChildren’sAirwayCenter.

. Recognizetheinterdisciplinarypositionoftheneurotologistinthecareoflateralskullbasedisorders.3

HEAD&NECK/FACIALPLASTICSRS.HACKMAN,SHORES,WEISSLER/DR.SHOCKLEYD

PGY3:HEAD&NECK/FACIALPLASTICS(HF)GoalshegoalsofthePGY3rotationonthisrotationaretobegintounderstandthediagnosisandmultidisciplinary

sa3monthrotation.Ttreatmentofheadandnecktumors.ThisiarnLe ingObjectives–CoreCompetencies

Professionalism:1. Completetheintroductorymaterialandthefirst3vignettesof“ProfessionalisminSurgery:Challenges andChoices”DVD.2. ReadGruenRL,AryaJ,CosgroveEM,CruessRL,CruessSR,EastmanAB,FabriRJ,FriedmanP,KirkseyTD,

ookEG,HarkenAH;Oct;197(4):605‐8.

KodnerIJ,LewisFR,LiscumKR,OrganCH,RosenfeldJC,RussellTR,SachdevaAK,Z AmericanCollegeofSurgeonsTaskFroceonProfessionalism.JAmCollSurg.20033. ReadACSTaskForceonProfessionalism.JAmCollSurg.2004Nov;199(5):734‐5.4. Addressespatientandpatients’familieswithrespecttotheircultureandgender.

ndneckcancerpatientsincorporatingintodailypractice.

5. Learnsandpracticesethicalbehaviorinthetreatmentofheadatheconceptsofbeneficence,non‐maleficence,patientautonomy

eandendoflifecare.6. ActivelyconsiderandreadaboutpalliativInterpersonal&CommunicationSkills:1. Practiceactivelisteningwhileinterviewingnewpatients.

ts,2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresidenattendings,nursingandoperatingroomstaff.

riateinteractionswithmultispecialtycolleaguesinaheadandnecktumorboard.3. PracticeappropMedicalKnowledge:

kanatomy.andelectrolytephysiologyofthesurgical

1. Headandnec2. Perioperativecareincludingfluid

patient.3. Perioperativepainmanagement.

actiPr ce‐BasedLearning&Improvement:1. ParticipateinHeadandNeckcadaverdissectionsyearlyincorporatingprincipleslearnedfromdidactic sessions.

ctadditionalreading2. Participateintheweeklyheadandnecktumorboardandusetheexperiencetodire

g. ontimelytopics.. Examineresidentsownoperativelistandobtainadditionaltrainingwherelackin

rthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies34. Conside

tien

,bronchoscopyandesophagoscopy.Pa tCare:

dinglaryngoscopyeheadandneck.

1. Endoscopytechniquesinclu2. Basicsurgicalexposureinth3. Woundclosuretechniques.

em.Systems‐BasedPractice:1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSyst. LearnpropercodingandbillingprocessesforbothclinicandOR.. LearntousethevariousaspectsoftheWebCIS,theUNCelectronicmedicalrecord.23PGY4:HEAD&NECK/FACIALPLASTICS(HF)GoalsThegoalsforthePGY4residentonthisrotationaretolearnthemultidisciplinarycareoftheheadandneckancerpatientinthegreatercontextofhealthcare,aswellastobecomemoreproficientinthesurgeries

monthrotation.crequiredtoresectsuchtumors.Thisisa3arnLe ingObjectives–CoreCompetencies

Professionalism:1. Completethe4ththroughthe15thvignettesof“ProfessionalisminSurgery:ChallengesandChoices” DVD.

theAmericanCollegeof2. Listentothe“EthicsandPhilosophyLecture”OnPatientSafetyCDProgramfrom Surgeons.3. Addressespatientandpatients’familieswithrespecttotheircultureandgender.

ndneckcancerpatientsincorporatingintodailypractice.

4. Learnsandpracticesethicalbehaviorinthetreatmentofheadatheconceptsofbeneficence,non‐maleficence,patientautonomy

eandendoflifecare.5. ActivelyconsiderandreadaboutpalliativInterpersonal&CommunicationSkills:. Listento“EffectiveCommunication:anEssentialCompetencytoEnhanceSurgicalCare,PromoteSafety,

bility”OnPatientSafetyCDProgramfromtheAmericanCollegeofSurgeons.1 andReduceLiaMedicalKnowledge:

logy.1. Oncogenesis.. Basicradiationbio23. Lasertechnology.

actiPr ce‐BasedLearning&Improvement:1. ParticipateinHeadandNeckcadaverdissectionsyearlyincorporatingprincipleslearnedfromdidactic sessions.

ctadditionalreading2. Participateintheweeklyheadandnecktumorboardandusetheexperiencetodire

. ontimelytopics.. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking

rthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.34. Conside

tienPa tCare:

onsillarfossa.1. Submandibularglandresection.2. Basictransoralapproachestotheoralcavityandt3. Locatethefacialnerveinparotidectomysurgery.

4. Locatetheparathyroidglandsandrecthyroidectomysurgery.

noplasty,face‐lift.

urrentandexternalbranchofthesuperiorlaryngealnervein5. Blepharoplasty,rhiSystems‐BasedPractice:1. LearnaboutUNCP&AanditsrelationshipwiththeHealthCareSystem.2. LearnpropercodingandbillingprocessesforbothclinicandOR.. Learntouseadjunctstohealing,suchasproductsdesignedtominimizescar,avoidanceofsunand

exercisetomaintainoptimalresultsincosmeticprocedures.3PGY5:HEAD&NECK/FACIALPLASTICS(HF)GoalsThegoalsforthePGY5residentonthisrotationaretobecomeproficientintheextirpationandreconstructionofheadandneckcancers,tounderstandendoflifeissues,andtobecomethetypeofsurgeonmostcapableofeliveringexpertcare.Furthergoalsrelatetodevelopingexpertiseinfacialplasticsurgeryandcosmeticas

sisa3monthrotation.dwellasfunctionalsurgeryontheface.ThiarnLe ingObjectives–CoreCompetencies

Professionalism:llengesandChoices”1. Completethe16ththroughthe24thvignettesof“ProfessionalisminSurgery:Cha

DVD.2. Addressespatientandpatients’familieswithrespecttotheircultureandgender.

ndneck cancerpatientsincorporatingintodailypractice.

3. Learnsandpracticesethicalbehaviorinthetreatmentofheadatheconceptsofbeneficence,non‐maleficence,patientautonomy

lliativeandendoflifecare.4. ActivelyconsiderandreadaboutpaInterpersonalandCommunicationSkills:. Listento“TheDisruptiveProfessional”OnPatientSafetyCDProgramfromtheAmericanCollegeof1 Surgeons.

ftheH&Ncancerpatient.MedicalKnowledge:1. Complexmultidisciplinarycareo. Advancedimageinterpretation.23. Pathologyoftheheadandneck.

actiPr ce‐BasedLearning&Improvement:

om1. Listento:“TheVolumeandQualityConundrum:WhataretheData”OnPatientSafetyCDProgramfr theAmericanCollegeofSurgeons.. Listento:“Practice‐BasedLearningandImprovement:anEssentialComponentofMOC”OnPatient

DProgramfromtheAmericanCollegeofSurgeons.2 SafetyC

tien

lotomy;lateralrhinotomy.Pa tCare:

aches:mandibularyngectomy.

1. Advancedappro2. Partialandtotal3. Thyroidectomy.

4. Parotidectomy.5. Radicalandselectiveneckdissection.. Advancedendoscopicapproaches.

ty,vascularizedflaps.67. AdvancedrhinoplasSystems‐BasedPractice:

from1. Listento“AccreditationofSurgeryCenterstoOptimizePatientCare”OnPatientSafetyCDProgram theAmericanCollegeofSurgeons.2. Listento“ImprovingPatientSafetyintheOperatingRoom”OnPatientSafetyCDProgramfromthe AmericanCollegeofSurgeons.

CONSULTSERVICECHIEFPGY5:CONSULTSERVICECHIEFRESPONSIBILITIESGoalsheconsultchiefrunstheconsultserviceandinterfaceswiththechiefresidentsontheotherOTO‐HNSTservices.Thisisa3monthrotation.arnLe ingObjectives–CoreCompetenciesr sionalism:

acceptanceofconsultsintotheOTO‐HNSservice.P ofes1. PresentasanagreeableportalforInterpersonal&CommunicationSkills:

sincoordinationwiththe1. Makesandcommunicatestheservice/clinicscheduleforthe3monthsblock servicechiefs.. ResponsibleforsettingupalldidacticsexceptThursPMserviceconference

ttendingphysiciansonallotherservicesifconflictsariseinconsultcare.23. Interactswitha

dice alKnowledge:

rticlesonconsultcaseswhichpresent.M1. Readsjournalarticlesandtextbooka

actir ce‐BasedLearning&Improvement:

andEMTALA,Hospice,dischargeplanningtoinstitutionsand/orhome.P1. Underst

tiena tCare:

ningroundseverymorning.P1. Responsibleforrun

stemy s‐BasedPractice:

nterfacewithotherservicestomaximizeeducationalopportunitiesforeachresident.S1. IPGY3:

efashion.Professionalism:

atening,conservativithotherservices.

1. Presentinanon‐thre2. Avoideventconflictw3. ComplywithHIPAA.

erpnt ersonal&CommunicationSkills:

nsultingservicesbyintroductionofselfandexpectationofconsult.I1. Interactwithco

nferences.MedicalKnowledge:. Participateinco

TALA.12. NeedEM

tiena tcare:

allconsultstoseniorresidentand/orattending.P1. AssessandpresentSystems‐BasedPractice:1. Learnpropercompletionofconsultsincludingcompletionofelectronicmedicalrecords(WebCIS).

RHINOLOGY/LARYNGOLOGYNATIONDRS.EBERT,SENIOR/DRS.BUCKMIRE,ZA

GOLOGY(RL)

PGY3:RHINOLOGY/LARYNThisisa3monthrotation.arnLe ingObjectives–CoreCompetencies

Professionalism:1. Residentsmustpresentinacleanandprofessionalfashionwithacleanlabcoat.. Washeshandsinfrontofpatientandbetweeneachpatientcontact.

milieswithrespecttotheircultureandgender.23. Addressespatientandpatients’faInterpersonal&CommunicationSkills:1. Practiceactivelisteningwhileinterviewingnewpatients.

entsand2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresid attendings.

3. Practiceappropriate,professionalinteractionswithmedicalstudentsandvisitinginternational physicians.4. Residentdemonstratesproficiencyingatheringandassimilatingdatafromothercollaborative specialtiesinthemulti‐disciplinaryvoiceandswallowingclinic(GI,SpeechPathology,andNeurology).

Thedataisthenpresentedinanorganizedfashiontotheattendingphysicianofseniorresidentstaffon service.MedicalKnowledge(Goals):

ts1. Tounderstandtheanatomyofthenasalcavity,paranasalsinusesandanteriorskullbaseaswellasi basicembryology.2. Tounderstandanddescribetheexpectedoutcomesofmedicalandsurgicalmanagementofchronic rhinosinusitisandchronicrhinitisandmethodsofassessment.

3. Torecognizepotentialcomplicationsofendoscopicsinussurgeryandtoknowtheirappropriate treatment.4. Torecognizepotentialcomplicationsofallergytestingandallergyserumadministrationandtoknow theirappropriatetreatment.5. ResidentcompletesthecoredidacticreadingmaterialfortherotationincludingselectedLaryngology a hapters.rticlesandbookc

.Toachievegoals:a Readsandcompletesassignmentsindidacticeducationcourse. (i.e.Readandpresentchapters/articlesfromHomestudyandrhinologytextbook:Kennedy’s

“DiseasesoftheSinuses”)b. Developunderstandingofsinonasalanatomy/pathologyfromlectures,dissectioncourses(yearly

SouthernStatesRhinologyCourse),aswellasfromOR/clinicexams.AttendResidentAllergy fthecourseonceduringresidency.Reference:KennedyDW,BolgerW,ZinreichS(eds):Diseaseso Sinuses,DiagnosisandManagement.Hamilton,B.C.Decker,2001.

c. Readthemedicalliteratureandshowanunderstandingoftherelevantrecentliteratureasit appliestomanagementofallergic,inflammatorysinusdisease,andskullbaseneoplasms.

atabasestolookupinformationoncurrentd. UsePubMed,UptoDateandotherweb‐basedd

patients.orduptodate.

e. Keeptheelectronicmedicalrec

act

iPr ice‐BasedLearning&Improvement:

d.

1. ParticipateinSinusdissectioncourseyearlyincorporatingprincipleslearnedfromtsownoperativelistandobtainadditionaltrainingwherelacking

dacticsessions.2. Examineresiden

Considtien

3. erthecost‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.Pa tCare(Goals):

,1. Tounderstandtheproperevaluationofthepatientwithsinonasalorallergicdiseaseaswellas indicationsforendoscopicsinus/skullbasesurgery.2. Tounderstandtheevidencebasedmedicalmanagementofthepatientwithsinonasaldisease.3. Tobecomefamiliarwithbasicendoscopicsurgicalplanningandset‐up.

proficientlyevaluate4. Tounderstandtheadministrationandinterpretationoflaboratorytestsandto radiographicimagesoftheparanasalsinuses.5. Tolearninstrumentsusedforendoscopicsinussurgeryandroutineclinicuse.

6. Todescribethepropertechniquesandstepsinendoscopicsinussurgery:anteriorethmoidectomy,and middlemeatalantrostomy. 7. Todescribethepropertechniquesforinvitro,skinprick,andintradermalallergytestingandmixingof

patientspecificserum.8. Residentdemonstratesfacilityinobtainingasub‐specialty(laryngology)focusedhistoryandphysical,

performingofficebasedendoscopy/stroboscopyandcommunicatingaconcisepresentationofthesalientf ndingphysician.

eaturestotheatte

Toachievegoals: a. ActivelyparticipateinoutpatientclinicsandOR’swithattendingsandallergynursingstaff. b. Independentlyperformcomprehensiveallergyandrhinologichistory,physicalexamination (includingnasalendoscopywithrigidandflexibletelescopes)andorderingofappropriate diagnostictestingfortheclinicalproblem.

c. Makeapresumptivediagnosesandsynthesizeatreatmentplansforclinicandconsultpatients. Then,presentpatientstotheattendinginanorganizedandmannerforcritique.

t d. Learnandapplysurgicalindicationsfortreatmentofsinonasaldiseasebyincorporatinglabtes andradiographicimagingintodecision‐makingprocess.

e. Followpatientsfromadmissiontodischarge:determiningappropriatetimefordischargeand follow‐up.Sys s‐Batem sedPractice:

1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.theHillsboroughHospitalandits2. Discussactivelythebuildingofnewhealthcareresourcessuchas

effectonpatientcareandphysicianlivelihood.3. LearnpropercodingandbillingprocessesforbothclinicandOR.

GOLOGY(RL)GY4:RHINOLOGY/LARYNPThisisa3monthrotation.arnLe ingObjectives–CoreCompetencies

Professionalism:1. Residentsmustpresentinacleanandprofessionalfashionwithacleanlabcoat.. Washeshandsinfrontofpatientandbetweeneachpatientcontact.

milieswithrespecttotheircultureandgender.23. Addressespatientandpatients’faInterpersonal&CommunicationSkills:1. Practiceactivelisteningwhileinterviewingnewpatients.

entsand2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresid attendings.3. Practiceappropriate,professionalinteractionswithmedicalstudentsandvisitinginternational physicians.4. Residentiscapableofmanaginghospital‐based,sub‐specialty(laryngology)consultsfromotherservices, includingclearcommunicationofthedetailsofthecasetotheattendingphysician.Thereafter,the

residentmanages/arrangesboththecommunicationandcarrying‐outoftheplanwiththeprimaryteam,includingadditionaltesting,testinterpretationandpotentiallysurgicalintervention.

MedicalKnowledge(Goals):

ts1. Tounderstandtheanatomyofthenasalcavity,paranasalsinusesandanteriorskullbaseaswellasi basicembryology.

ic2. Tounderstandanddescribetheexpectedoutcomesofmedicalandsurgicalmanagementofchron rhinosinusitisandchronicrhinitisandmethodsofassessment.3. Torecognizepotentialcomplicationsofendoscopicsinussurgeryandtoknowtheirappropriate treatment.4. Torecognizepotentialcomplicationsofallergytestingandallergyserumadministrationandtoknow theirappropriatetreatment.

5. ResidentdemonstratesproficiencyininterpretingFEESswallowingstudies,stroboscopicexaminations anddevelopsacompetentdifferentialdiagnosisandtreatmentplanforpresentationtotheAttending physician.

Toachievegoals:

a. Readsandcompletesassignmentsindidacticeducationcourse.,i.e.Readandpresent chapters/articlesfromHomestudyandrhinologytextbook:Kennedy’s“DiseasesoftheSinuses”.

b. Developunderstandingofsinonasalanatomy/pathologyfromlectures,dissectioncourses(yearly SouthernStatesRhinologycourse),aswellasfromOR/clinicexams.AttendResidentAllergycourse onceduringresidency.Reference:KennedyDW,BolgerW,ZinreichS(eds):Diseasesofthe Sinuses,DiagnosisandManagement.Hamilton,B.C.Decker,2001.

c. Readthemedicalliteratureandshowanunderstandingoftherelevantrecentliteratureasit

ysinusdisease,andskullbaseneoplasms.atabasestolookupinformationoncurrentpatients.

appliestomanagementofallergic,inflammatord. UsePubMed,UptoDateandotherweb‐basedd

orduptodate.e. Keeptheelectronicmedicalrec

acti

idacticsessions.Pr ce‐BasedLearning&Improvement:

d.

1. ParticipateinSinusdissectioncourseyearlyincorporatingprincipleslearnedfrom. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking

st‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.23. Considertheco

ienPat tCare(Goals):

,1. Tounderstandtheproperevaluationofthepatientwithsinonasalorallergicdiseaseaswellas indicationsforendoscopicsinus/skullbasesurgery.2. Tounderstandtheevidencebasedmedicalmanagementofthepatientwithsinonasaldisease.3. Tobecomeproficientinbasicendoscopicsurgicalplanningandset‐up.

ntlyevaluate4. Tounderstandtheadministrationandinterpretationoflaboratorytestsandtoproficie radiographicimagesoftheparanasalsinuses.5. Tolearnanduseinstrumentsusedforendoscopicsinussurgeryandroutineclinicuse.6. Todescribeandperformthepropertechniquesandstepsinendoscopicsinussurgery:anterior

ethmoidectomy,andmiddlemeatalantrostomy,completesphenoethmoidectomy,endoscopicandopen septoplasty,aswellasclinic‐basedpost‐opcare.7. Toperformthepropertechniquesforinvitro,skinprick,andintradermalallergytestingandmixingof

patientspecificserum.8. ResidentsisproficientwithbasicLaryngologyoperativetechniquesincludingsuspensionlaryngoscopy, vocalfoldinjection,microdirectlaryngoscopywithexcisionaswellashavingaworkingknowledgeof m tion,laryngoscopeselectionandORroomset‐up.icroinstrumenta

Toachievegoals:a. ActivelyparticipateinoutpatientclinicsandOR’swithattendingsandallergynursingstaff.b. Independentlyperformcomprehensiveallergyandrhinologichistory,physicalexamination

(includingnasalendoscopywithrigidandflexibletelescopes)andorderingofappropriatediagnostictestingfortheclinicalproblem.

c. Makeapresumptivediagnosesandsynthesizeatreatmentplansforclinicandconsultpatients.Then,presentpatientstotheattendinginanorganizedandmannerforcritique.

d. Learnandapplysurgicalindicationsfortreatmentofsinonasaldiseasebyincorporatinglabteandradiographicimagingintodecision‐makingprocess.

e. Followpatientsfromadmissiontodischarge:determiningappropriatetimefordischargeand

st

follow‐up.Systems‐BasedPractice:1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.

theHillsboroughHospitalanditseffect2. Discussactivelythebuildingofnewhealthcareresourcessuchasonpatientcareandphysicianlivelihood.

. LearnpropercodingandbillingprocessesforbothclinicandOR.3

GOLOGY(RL)GY5:RHINOLOGY/LARYNPThisisa3monthrotation.arnLe ingObjectives–CoreCompetencies

Professionalism:1. Residentsmustpresentinacleanandprofessionalfashionwithacleanlabcoat.. Washeshandsinfrontofpatientandbetweeneachpatientcontact.

milieswithrespecttotheircultureandgender.23. Addressespatientandpatients’faInterpersonal&CommunicationSkills:1. Practiceactivelisteningwhileinterviewingnewpatients.

entsand2. Practiceappropriate,professionalinteractionswithreferringphysicians,juniorandseniorresid attendings.3. Practiceappropriate,professionalinteractionswithmedicalstudentsandvisitinginternational physicians.4. Residentdiscussesthedetailsofoperativeprocedurewiththepatientincludingrisksbenefits,expected outcomes,post‐operativerecommendationsandwork‐relateddetails(i.e.Voicerest,returntowork).

Theresidentiscapableofinteractingwiththeschedulingpersonnelandtheancillaryservices(Speechgtheprocedureandsubsequentpost‐operativecare.

Pathology)forarranginMedicalKnowledge(Goals):

ts1. Tounderstandtheanatomyofthenasalcavity,paranasalsinusesandanteriorskullbaseaswellasi basicembryology.

ic2. Tounderstandanddescribetheexpectedoutcomesofmedicalandsurgicalmanagementofchron rhinosinusitisandchronicrhinitisandmethodsofassessment.3. Torecognizepotentialcomplicationsofendoscopicsinussurgeryandtoknowtheirappropriate treatment.

4. Torecognizepotentialcomplicationsofallergytestingandallergyserumadministrationandtoknow theirappropriatetreatment.5. Residentdemonstratesproficiencyintheinterpretationofvoiceandswallowingwork‐upaswellas

diagnosticstudies,andcanplanandarticulateanoperativeplanincludingrisksbenefitsandalternativest ardofcaretreatments.

othestand

Toachievegoals:ucationcourse.a Readsandcompletesassignmentsindidacticed.

i.e.Readandpresentchapters/articlesfromHomestudyandrhinology textbook:Kennedy’s“DiseasesoftheSinuses”.b. Developunderstandingofsinonasalanatomy/pathologyfromlectures,dissectioncourses(yearly

SouthernStatesRhinologycourse),aswellasfromOR/clinicexams.AttendResidentAllergycourse

onceduringresidency.Reference:KennedyDW,BolgerW,ZinreichS(eds):Diseasesofthe Sinuses,DiagnosisandManagement.Hamilton,B.C.Decker,2001.c. Readthemedicalliteratureandshowanunderstandingoftherelevantrecentliteratureasit

ysinusdisease,andskullbaseneoplasms. atabasestolookupinformationoncurrentpatients.

appliestomanagementofallergic,inflammatord. UsePubMed,UptoDateandotherweb‐basedde. Keeptheelectronicmedicalrecorduptodate.

acti

idacticsessions.Pr ce‐BasedLearning&Improvement:

d.

1. ParticipateinSinusdissectioncourseyearlyincorporatingprincipleslearnedfrom. Examineresidentsownoperativelistandobtainadditionaltrainingwherelacking

st‐benefitanalysisofvariousdiagnosticandtreatmentstrategies.23. Considertheco

ienPat tCare(Goals):

,1. Tounderstandtheproperevaluationofthepatientwithsinonasalorallergicdiseaseaswellas indicationsforendoscopicsinus/skullbasesurgery.2. Tounderstandtheevidencebasedmedicalmanagementofthepatientwithsinonasaldisease.3. Tomasterbasicendoscopicsurgicalplanningandoperativeset‐up.

raphicimages4. Toefficientlyadministerandinterpretlaboratorytestsandtoproficientlyevaluateradiog oftheparanasalsinuses.5. Toproficientlyuseinstrumentsusedforendoscopicsinussurgeryandroutineclinicuse.6. Todescribeandperformthepropertechniquesandstepsinendoscopicsinussurgery:anterior ethmoidectomy,middlemeatalantrostomy,completesphenoethmoidectomy,endoscopicandopen septoplasty,clinic‐basedpost‐opcare,frontalrecessdissection,revisionsurgeryandforextended applicationsincludingtumorremoval,CSFleakrepair,hypophysectomy,orbitaldecompression,and opticnervedecompression. f7. Toperformthepropertechniquesforinvitro,skinprick,andintradermalallergytestingandmixingo

patientspecificserum.8. Residentdemonstratesproficiencyispreppingandperformingofficebased,non‐sedatedprocedures

includingvocalfoldinjectionandtransnasalesophagoscopy.Theseniorresidentmustbeabletoa ribethenuancesofintraoperativedecisionmakinginlaryngealframeworksurgery.

ppropriatelydesc

Toachievegoals:a. ActivelyparticipateinoutpatientclinicsandOR’swithattendingsandallergynursingstaff.b. Independentlyperformcomprehensiveallergyandrhinologichistory,physicalexamination

(includingnasalendoscopywithrigidandflexibletelescopes)andorderingofappropriatediagnostictestingfortheclinicalproblem.

c. Makeapresumptivediagnosesandsynthesizeatreatmentplansforclinicandconsultpatients.Then,presentpatientstotheattendinginanorganizedandmannerforcritique.

d. Learnandapplysurgicalindicationsfortreatmentofsinonasaldiseasebyincorporatinglabteandradiographicimagingintodecision‐makingprocess.

e. Followpatientsfromadmissiontodischarge:determiningappropriatetimefordischargeand

st

follow‐up.Systems‐BasedPractice:1. LearnaboutUNCP&AanditsrelationshipwiththeUniversityandHealthCareSystem.

oroughHospitalanditseffect2. DiscussactivelythebuildingofnewhealthcareresourcessuchastheHillsb onpatientcareandphysicianlivelihood.3. LearnandapplypropercodingandbillingprocessesforbothclinicandOR.